Factors Associated With the Overuse of Colorectal Cancer Screening: A Systematic Review

Abstract

This systematic review examined factors associated with overuse of colorectal cancer (CRC) screening. The authors searched MEDLINE and EMBASE from January 1998 to March 2017. Studies were included if they were written in English, contained original data, involved a US population, and examined factors potentially associated with overuse of CRC screening. Paired reviewers independently screened abstracts, assessed quality, and extracted data. In 8 studies, the associations between patient factors, including age, sex, race, and number of comorbidities, were tested and were inconsistently associated with CRC screening overuse. Overuse of screening was greater in the Northeast/Mid-Atlantic regions and in urban areas and was lower in academically affiliated centers. Although the literature supports important overuse of CRC screening, it remains unclear what drives these practices. Future research should thoroughly explore these factors and test the impact of interventions to reduce overuse of screening.

Primary care clinicians’ perceptions of colorectal cancer screening tests for older adults

“…In the United States, large-scale screening programs have led to a significant decrease in CRC mortality ( Siegel et al, 2017 , Arnold et al, 2017 ). However, CRC screening of older adults remains challenging with literature showing that both under- and over-screening exist ( Cokkinides et al, 2003 , Seeff et al, 2002 , Predmore et al, 2018 ). Appropriate CRC screening in older adults requires balancing the long-term benefits of screening with significant, often short-term, harms and communicating these benefits and harms with patients so they can make informed decisions ( Kotwal and Schonberg, 2017 ).…”

Induced Demand in Cancer Diagnosis

“…Utilizing defensive medicine and ignoring clinical practice guidelines (CPGs) are also mentioned as factors that increase the probability of overusing imaging techniques (15)(16)(17)(18)21). A lack of clear standards and adequate details about patients' characteristics are noted in another study (13).…”

Characteristics Associated with Low-Value Cancer Screening Among Office-Based Physician Visits by Older Adults in the USA

“…10,21,22 Findings on the link between age and overuse of colorectal cancer screening have been mixed. 23 If guidelinebased age thresholds are being used at all, these findings suggest that they are being applied by clinicians and patients at best as a blurry boundary, perhaps representing the uncertainties inherent in using age as a proxy for life expectancy. 6 At the same time, even rough estimates of life expectancy or health status could supplement age as a screening threshold.…”

“…10,20,31,32 Provider-directed interventions could examine whether offering additional training on cancer screening guidelines or shared decision-making is effective in reducing inappropriate screening referrals, or whether additional systems-based interventions (e.g., EHR-alerts, special protocols) might be required. 20,23 When implementing such interventions, it will be important to keep in mind that many older adults have positive views of cancer screening and thus may be uncomfortable with or even opposed to discontinuing screening. [33][34][35] Although studies have begun to investigate acceptable strategies for communicating with patients about stopping cancer screening, 32,[35][36][37] more research is needed.…”