JAMA: Elderly often given unnecessary tests for colon cancer screening

Despite recommendations that most seniors over age 75 should not receive unnecesssary colonoscopies and other invasive procedures as screening measures for colon cancer, many providers continue to give them, notes a study published in this week’s online JAMA Internal Medicine.

The study, conducted using Medicare data from 2008–2009 in the state of Texas, found that almost 30 percent of the overall patients were given a colonoscopy when there had been no prior indication that one was needed. Rates climbed to nearly 40 percent within the age bracket of 76–85. Older adults who lived in populated or urban areas were more likely to have a “potentially or probably inappropriate” colonoscopy than those living in rural areas, the study found.

“Complications from colonoscopy are increased in older populations (aged 75 years or older),” the study authors wrote. “Moreover, competing causes of mortality with advancing age (ie, causes of death other than colorectal cancer) shift the balance between life-years gained and colonoscopy risks.”

Starting in 2008, the U.S. Preventive Services Task Force (USPSTF) began discouraging routine colon screenings for those over 75 because the risks during the procedure—usually a colonoscopy or sigmoidoscopy—outweigh the benefits of the test. Complications with invasive procedures can include “perforation, major bleeding, diverticulitis, severe abdominal pain, and cardiovascular events” in 25 out of every 10,000 procedures, the guide states.

The USPSTF still strongly recommends proactive screenings for those between 50 and 75, but suggests using non-invasive tests first, and using invasive tests only when indicated.

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