Screening colonoscopy often used inappropriately in elderly
Many Elderly Consider Cancer Screening Obligatory
(HealthDay News) -- Many older adults consider cancer screening to be morally obligatory, but screening colonoscopy is often given inappropriately in the elderly, according to two studies published online March 11 in JAMA Internal Medicine.
In the first study, Alexia M. Torke, M.D., from Indiana University in Indianapolis, and colleagues interviewed 33 older adults (63 to 91 years old) presenting to a senior health center regarding cancer screening cessation. The researchers found that screening tests were seen as morally obligatory and cessation of screening would require a major decision. Most had never discussed screening cessation with their physician, and although some would accept a physician's recommendation to stop, others regarded such a recommendation as a threat to trust. Subjects were more willing to stop after considering risks and benefits, complications, or test burdens.
In the second study, Kristin M. Sheffield, Ph.D., from the University of Texas Medical Branch in Galveston, and colleagues analyzed the frequency of inappropriate screening colonoscopy (based on age or too soon after a negative colonoscopy) among 74,681 Medicare beneficiaries in Texas from 2008 to 2009. The researchers found that 23.4 percent of colonoscopies were potentially inappropriate. Colonoscopists who performed a greater percentage of colonoscopies than the mean were often surgeons, graduates of medical schools in the United States, medical school graduates before 1990, and higher-volume colonoscopists.
"Because some older adults may not live long enough for a screen-detectable cancer to become clinically significant, the benefits of screening in older adults, particularly those in poor health, are not established," write the authors of an accompanying editorial.
One author from the Torke study is a consultant to the National Pharmacy and Therapeutics Committee of CVS Caremark.