Colon Cancer Screening in <scp>U</scp>.<scp>S</scp>. Adults Aged 65 and Older According to Life Expectancy and Age

Schonberg, Mara A.; Breslau, Erica S.; Hamel, Mary Beth; Bellizzi, Keith M.; McCarthy, Ellen P.

doi:10.1111/jgs.13335

Cited by 51 publications

(66 citation statements)

References 27 publications

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“…As a result, we specifically focused on a subsample of average-risk beneficiaries age 86 to 95 years for whom any screening may be considered potential overuse according to USPSTF recommendations. 4,11,[18][19][20] …”

Section: -10mentioning

confidence: 99%

Assessing Colorectal Cancer Screening Adherence of Medicare Fee-for-Service Beneficiaries Age 76 to 95 Years

Bian

Bennett

Cooper³

et al. 2016

JOP

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PROBLEM FACED: There is a growing concern about potential overuse of colorectal cancer (CRC) screening services in part because the U.S. Preventive Services Task Force (USPSTF) recommends against routine CRC screening of average-risk individuals over age 75 years. This study examined rates of CRC screening adherence, defined by Medicare coverage policy, among average-risk Medicare fee-for-service (FFS) beneficiaries age 76 to 95 years.WHAT WE DID: Using a 2002-2010 5% random non-cancer sample of Medicare beneficiaries residing in the SEER areas, we constructed a 9-year cohort that included average-risk beneficiaries age 76 to 95. Two outcomes of interest were (1) up-to-date status of overall CRC screening adherence and (2) up-to-date status of adherence to colonoscopy versus other screening modalities (i.e., fecal occult blood test, flexible sigmoidoscopy, and double-contrast barium enema), conditional on patient adherence. Because of our claims-data-based method used for determining the up-to-date adherence status, we further focused on a subsample of averagerisk beneficiaries age 86 to 95, for whom any screening services used may be considered potential overuse by USPSTF recommendations. WHAT WE FOUND:Overall CRC screening adherence rates of Medicare beneficiaries age 76 to 95 increased from 13.0% to 21.4% from 2002 to 2010. In 2002, 2.2% were adherent to colonoscopy and 10.7% by the other modalities, and the corresponding rates were 19.5% and 1.9% in 2010. In addition, the rates of adherence to colonoscopy were 1.1% for those age 86 to 90 and almost nil for those age 91 to 95 in 2002, but became 13.5% and 8.2% in 2010, respectively. The Figure shows the rates of CRC screening adherence by modality among those age 86 to 90 and 91 to 95 combined. In contrast to whites, blacks age 76 to 95 had 7-percentage-point lower adherence rates. However, overall adherence rates among blacks increased by 168.6% from 2002 to 2010, while rates among whites increased by 63.0%. INTERPRETATION:The rapid rise in overall adherence rates may be linked to Medicare coverage policy of screening colonoscopy for average-risk beneficiaries starting in 2001, and to colonoscopy's 10-year screening interval. Our subsample analysis of those age 86 to 95 showed that the overall adherence rates almost doubled, rising from 6.7% to 12.5% from 2002 to 2010.These increases, largely driven by colonoscopy use, may represent at least some overuse of CRC screening services. However, this study could not fully evaluate appropriateness of CRC screening services because the USPSTF recommends case-by-case consideration of screening for average-risk individuals age 75 to 84. REAL-LIFE IMPLICATIONS:To our knowledge, this is the first study evaluating rates of CRC screening adherence among average-risk, Medicare FFS beneficiaries since Medicare began to reimburse for average-risk screening colonoscopy in 2001.We observed that high proportions of very elderly average-risk Medicare FFS beneficiaries received colonoscopies in spite of USPSTF recommendations for...

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Section: -10mentioning

confidence: 99%

Assessing Colorectal Cancer Screening Adherence of Medicare Fee-for-Service Beneficiaries Age 76 to 95 Years

Bian

Bennett

Cooper³

et al. 2016

JOP

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“…13 However, adequate screening is not performed in healthy older adults with a relatively long life expectancy who may benefit from cancer screening, possibly as a result of age-based guidelines. 14,15,17,19,20 …”

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confidence: 99%

Primary Care Practitioners’ Views on Incorporating Long-term Prognosis in the Care of Older Adults

et al. 2016

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“…15, 27, 39 Challenges with bowel prep in older adults are common and include dizziness, abdominal pain, incontinence, and nausea, and individuals can have challenges with sedation post-procedure. 40 …”

Section: Colorectal Cancer Screeningmentioning

confidence: 99%

“…15 However, in 2010 an estimated 51% of adults >75 years with life expectancies <10 years reported being screened. 40 This can lead to risks from unnecessary testing as well as overdiagnosis. On autopsy studies of older adults, 10–33% are incidentally found to have colonic polyps and 2–3% have CRC suggesting the more we look the more we will find, but that we will not always improve patient quality or quantity of life.…”

Section: Colorectal Cancer Screeningmentioning

confidence: 99%

Cancer Screening in the Elderly

Kotwal¹,

Schonberg²

2017

Cancer J

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There is relatively limited data on outcomes of screening older adults for cancer; therefore, the decision to screen older adults requires balancing the potential harms of screening and follow-up diagnostic tests with the possibility of benefit. Harms of screening can be amplified in older and frail adults, and include discomfort from undergoing the test itself, anxiety, potential complications from diagnostic procedures resulting from a false-positive test, false reassurance from a false-negative test, and overdiagnosis of tumors that are of no threat and may result in overtreatment. In this paper, we review the evidence and guidelines on breast, colorectal, lung and prostate cancer as applied to older adults. We also provide a general framework for approaching cancer screening in older adults by incorporating evidence-based guidelines, patient preferences, and patient life expectancy estimates into shared screening decisions.

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Colon Cancer Screening in U.S. Adults Aged 65 and Older According to Life Expectancy and Age

Abstract: Older adults with little chance of benefit because of limited LE commonly undergo CRC screening, whereas many adults aged 65 to 75 with a 10-year LE or greater are not screened.

Cited by 51 publications

References 27 publications

Assessing Colorectal Cancer Screening Adherence of Medicare Fee-for-Service Beneficiaries Age 76 to 95 Years

Assessing Colorectal Cancer Screening Adherence of Medicare Fee-for-Service Beneficiaries Age 76 to 95 Years

Primary Care Practitioners’ Views on Incorporating Long-term Prognosis in the Care of Older Adults

Cancer Screening in the Elderly

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