Many colonoscopies performed for adults over age 70 may beunlikely to benefit them, according to a new study.
Such procedures expose people to the risks of a colonoscopy without evidence that they are likely to benefit from them, according to the study. For example, the colon cancer screening test may be considered inappropriate if it is done more often than recommended, or performed on patients who are older than 75.
In the study, 23.4 percent of colonoscopies done over a year for older adults were found to be inappropriate. The researchers primarily used data from Medicare claims in Texas.
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Where patients live and what physician they see affect the likelihood of undergoing an inappropriate procedure, said study researcher Kristin Sheffield, an assistant professor of surgery at the University of Texas Medical Branch. "For some physicians, more than 30 percent of the colonoscopies they performed were potentially inappropriate according to screening guidelines," she said.
The amount of variation between physicians in the study "suggests that there are some providers who are overusing colonoscopy for screening purposes in older adults," Sheffield said.
The U.S. Preventive Services Task Force [s1] recommends that people not known to be at high risk for colon cancer begin regular screening for the disease at age 50. For those opting to undergo colonoscopies (other screening options include a fecal occult blood test and flexible sigmoidoscopy), the procedure should be done every 10 years, and is not needed after age 75.
Colon cancer tends to progress slowly, Sheffield said, so early detection is less likely to benefit older adults. At the same time, colonoscopies come with the risk of complications, such as perforation of the intestine, bleeding or incontinence.
Inappropriate colonoscopies are not only unlikely to benefit patients, they also consume resources that could be used more effectively for the people who need colonoscopies and are not getting them, Sheffield said.
Sheffield and her colleagues looked at data on 75,000 colonoscopies performed in Texas between October 2008 and September 2009. For comparison, they also looked at data from claims across the U.S.
Ultimately, patients decide whether to undergo a colonoscopy. However, physicians and health care systems influence these decisions, the researchers wrote in their study.
The new findings mean that older patients and their providers should be aware of screening guidelines and the risks of colonoscopies. "We hope that there will be efforts to align screening practices with current guidelines," perhaps through better communication between doctors and public education campaigns to correct misperceptions, Sheffield said.
If older patients strongly prefer to undergo screening, then they and their providers could consider alternative screening methods that involve less risk, such as a test for occult blood in the stool, she said.
The study was published today (March 11) in the journal JAMA Internal Medicine.
Pass it on: Colonoscopies for older adults may carry unnecessary risks.
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