Colonscopy Not Advised for Sick Elderly

Study finds its risks may outweigh potential benefits

MONDAY, Oct. 10, 2005 (HealthDay News) -- Offering colonoscopies and other tests for colorectal cancers on a more routine basis could save lives, two new studies suggest.

However, researchers say doctors may also want to restrict the use of colonoscopies in ill, elderly patients.

While Americans regularly get cancer screens such as mammograms and Pap smears, they go less often for tests aimed at detecting colorectal malignancies. Only about 40 percent to 50 percent of people at risk of colorectal cancer -- which experts say includes everyone over the age of 50 -- undergo the appropriate screening tests, said Dr. Durado Brooks, director of colorectal cancer for the American Cancer Society.

"We're certainly far short of the 70 to 80 percent we see for other cancers," Brooks said.

Part of the problem may be the tests themselves, which include colonoscopies that are recommended once every 10 years for everyone aged 50 and older. While TV host Katie Couric has done much to raise the profile of colonoscopy since her husband's death from colorectal cancer, the procedure remains uncomfortable and potentially risky.

In some cases, "you take someone who's healthy and well, and expose them to a procedure that has some significant complications," Brooks said. "Most major organizations like the American Cancer Society simply list colonoscopy as one option for screening people at average risk."

Currently, there's no upper age limit for colorectal cancer screening, so doctors often continue doing so regardless of the age of patients, noted study co-author Dr. Amnon Sonnenberg, a researcher at Oregon Health & Science University, in Portland.

In their study, Sonnenberg and co-researcher Dr. Cynthia Ko compared the benefits and risks of screening people aged 70 to 94 for colorectal cancer.

The study findings appear in the current issue of Gastroenterology 2005.

The two researchers found that colonoscopy would be a good idea for healthy men aged 70 to 74 because it would take just 42 tests to prevent one fatal case of the disease.

But the tests aren't as effective for older people who are already sick. For example, doctors would need to give colonoscopies to 431 women in poor health aged 75 to 79 to prevent one fatal case, the researchers found.

If a patient isn't expected to live long because of extreme age or severe illness, "it does not make much sense to schedule a colonoscopy in order to prevent the possibility of a cancer in future that would not affect the patient's well-being within the next five years anyway," Sonnenberg said.

The findings aren't surprising, Brooks said. Doctors must consider both age and health condition before giving someone a colonoscopy, he noted. Even so, the test can still turn up cases of cancer even in the very elderly, he pointed out.

In another study in the same issue of the journal, researchers at the University of California at San Francisco tried to predict what would happen if 75 percent of the U.S. population were regularly screened for colorectal cancer.

The researchers estimate that an expanded testing program would save money in terms of the treatment of colorectal cancer cases, but would still boost costs overall by as much as $2.8 billion a year.

On the other hand, expanded screening could save as many as 15,000 lives annually, the researchers found.

According to study co-author Dr. Uri Ladabaum, a UCSF assistant clinical professor of medicine, "The key message for adults over 50 is that colorectal cancer screening can significantly decrease their risk of dying from colorectal cancer, and they should strongly consider getting screened."

More information

Learn more about colorectal screening from the U.S. Centers for Disease Control & Prevention.

Related Stories

No stories found.
logo
www.healthday.com