Assessing the Impact of Screening Colonoscopy on Mortality in the Medicare Population

Gross, Cary P.; Soulos, Pamela R.; Ross, Joseph S.; Cramer, Laura D.; Guerrero, Christopher; Tinetti, Mary E.; Braithwaite, R. Scott

doi:10.1007/s11606-011-1816-4

Cited by 23 publications

(21 citation statements)

References 50 publications

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“…van Hees' team also reported that fewer co-morbidities were associated with screening at older ages. 19 Lansdorp-Vogelaar et al 20 and Gross et al 21 whose studies are included in this review, also arrived at a similar conclusion.…”

Section: Colorectal Cancer Screeningsupporting

confidence: 71%

“…A summary of the literature review of screening for colorectal cancer is shown in Table 1. [11][12][13][14][15][16][17][18][19][20][21][22]27 Hong Kong Med J ⎥ Volume 23 Number 5 ⎥ October 2017 ⎥ www.hkmj.org To quantify the effect of screening colonoscopy on prevention, early detection, and overdiagnosis in the last 10 years (As above) Colonoscopies had the advantages of prevention and early detection, with a low risk of over-diagnosis; 180 000 colorectal cancers are estimated to have been prevented (97% were prevented by screening colonoscopies done up to age 75 years); 1/121 screening colonoscopies were early detected up to age 80 years (89% by screening colonoscopies up to age 75 years); over-diagnosed in 1/1089 screening colonoscopies (58% arose from screening colonoscopies done on those age >70 years)…”

Section: Colorectal Cancer Screeningmentioning

confidence: 99%

See 1 more Smart Citation

Cancer screening for older people: to screen or not to screen

et al. 2017

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Section: Colorectal Cancer Screeningsupporting

confidence: 71%

Section: Colorectal Cancer Screeningmentioning

confidence: 99%

Cancer screening for older people: to screen or not to screen

et al. 2017

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“…In such patients, screening is unlikely to be of benefit and may even be harmful, indicating overuse. 24 Yet, the vast majority of these patients have a life expectancy of more than 6 months, meaning that they would not have met our measure definition of overuse. The development of more clinically meaningful and patientcentered measures that take into account health status and patient preference is a topic of ongoing work.…”

Section: Discussionmentioning

confidence: 96%

Developing and Testing an Electronic Measure of Screening Colonoscopy Overuse in a Large Integrated Healthcare System

et al. 2016

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BACKGROUND: Most existing performance measures focus on underuse of care, but there is growing interest in identifying and reducing overuse. OBJECTIVE: We aimed to develop a valid and reliable electronic performance measure of overuse of screening colonoscopy in the Veterans Affairs Health Care System (VA), and to quantify overuse in VA. DESIGN: This was a cross-sectional study with multiple cross-sections. SUBJECTS: U.S. Veterans who underwent screening colonoscopy between 2011 and 2013. MAIN MEASURES: Overuse of screening colonoscopy, using a validated electronic measure developed by an expert workgroup. KEY RESULTS: Compared to results obtained from manual record review, the electronic measure was highly specific (97 %) for overuse, but not sensitive (20 %). After exclusion of diagnostic and high-risk screening or surveillance procedures, the validated electronic measure identified 88,754 average-risk screening colonoscopies performed in VA during 2013. Of these, 20,530 (23 %) met the definition for probable (17 %) or possible (6 %) overuse. Substantial variation in colonoscopy overuse was noted between Veterans Integrated Care Networks (VISNs) and between facilities, with a nearly twofold difference between the maximum and minimum rates of overuse at the VISN level and a nearly eightfold difference at the facility level. Overuse at the VISN and facility level was relatively stable over time. CONCLUSIONS: Overuse of screening colonoscopy can be measured reliably and with high specificity using electronic data, and is common in a large integrated healthcare system. Overuse measures, such as those we have specified through a consensus workgroup process, could be combined with underuse measures to improve the appropriateness of colorectal cancer screening.

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“…26,42 Also, when results are accurately negative, screening can have a positive distal outcome by providing long-term reassurance to older adults average, it takes 10 years before one death from breast and colorectal cancers are prevented for every 1000 patients screened. 1,40,41 These results suggest that there might be a minimum life expectancy of 10 years to see any mortality benefit from these cancer screening tests. 1,41 about their health.…”

Section: 3mentioning

confidence: 83%

An Individualized Approach to Cancer Screening Decisions in Older Adults: A Multilevel Framework

et al. 2016

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Guidelines for optimal cancer screening in older adults remain unclear, particularly for adults over the age of 75. While cancer screening in older adults may benefit some in good health, it may cause unnecessary burdens in others with limited life expectancy. Thus, a systematic approach to enable individualized cancer screening decisions in older adults is needed. We suggest a framework that guides such decisions through evidence-based approaches from multiple interactions, and that involves the patient, clinician, and healthcare system. An individualized approach considers differences in disease risk rather than the chronological age of the patient. This paper presents a comprehensive framework that depicts the independent and converging levels of influences on individualized cancer screening decisions in older adults. This Individualized Decisions for Screening (IDS) framework recognizes the reality of these interrelationships, including the tensions that arise when behaviors and outcomes are valued differently at the patient, clinician, and healthcare organization levels. Person-centered approaches are essential to advancing multilevel research of individualized cancer screening decisions among older adults.

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Assessing the Impact of Screening Colonoscopy on Mortality in the Medicare Population

Cited by 23 publications

References 50 publications

Cancer screening for older people: to screen or not to screen

Cancer screening for older people: to screen or not to screen

Developing and Testing an Electronic Measure of Screening Colonoscopy Overuse in a Large Integrated Healthcare System

An Individualized Approach to Cancer Screening Decisions in Older Adults: A Multilevel Framework

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