A significant number of Medicare patients undergo colonoscopies more frequently than recommended, according to a study published online in the Archives of Internal Medicine.
About 46% of 24,071 Medicare patients who had negative colonoscopy reports — screenings with no biopsy, fulguration or polypectomy performed — between 2001 and 2003 underwent a repeat exam within 7 years, sooner than the 10 years between screenings recommended by national gastrointestinal authorities, say researchers at the University of Texas Medical Branch in Galveston. They further note that 42.5% of these patients had no clear reason for undergoing the earlier exams.
A second Archives report suggests physicians should perform colonoscopies on patients who would benefit most from early cancer detection by limiting screenings for elderly patients with short life expectancies.
Researchers at the University of North Carolina in Chapel Hill analyzed the 7-year-follow-up care of 212 patients 70 years of age or older who received a positive fecal occult blood test result during colonoscopies performed in 2001. Of these patients, 118 underwent follow-up colonoscopies that discovered 34 significant adenomas and 6 cancers, according to the study. The report further notes that 46% of patients who did not undergo follow-up screenings died of other causes within 5 years of receiving the positive fecal occult blood test.
The findings contradict the "one-size-fits-all, screen everybody" approach, says Christine Kistler, MD, MASc, lead author of the UNC study. "If you're going to die in 5 years, why would we subject you to colonoscopies and biopsies?" she asks.
"While it is well known that colorectal cancer screening has enormous potential to substantially reduce the incidence of colorectal cancer, how to do so in an optimal way remains elusive," writes Patrick G. O'Malley, MD, MPH, in an accompanying opinion piece. He believes many questions remain about whom to screen and when, and what defines the proper interval between exams.
These 2 studies, he writes, "indicate that there is much room for improvement in the way we measure proper utilization of screening colonoscopy, ensure adequate follow-up, and evaluate net benefit among those who screen positive."
Daniel Cook
