Home E-Weekly August 19, 2014

Are Colonoscopies and Other Cancer Screenings Overused?

Published: August 18, 2014

Two studies appearing in the latest edition of JAMA Internal Medicine suggest that colonoscopies and other types of cancer screenings are overprescribed in older patients who have limited life expectancies, driving up healthcare costs and potentially harming patients.

In one study, more than 27,000 patients 65 or older were grouped by risk of 9-year mortality from low (25% or less) to very high (75% or more). Screening rates in the very high mortality risk group were 55% for prostate cancer, 41% for colorectal cancer, 38% for breast cancer and 31% for cervical cancer.

These results, say the authors, "raise concerns about overscreening, which not only increases healthcare expenditure but can lead to patient net harm." Creating simple and reliable ways to assess life expectancy, they say, may benefit patients and substantially reduce costs.

A second study found that performing repeat colonoscopies every 5 years, instead of the recommended 10, on Medicare beneficiaries who'd had negative screenings at age 55 provided little benefit, was "inefficient from a societal (cost) perspective," and was often "unfavorable for those being screened," because of large increases in colonoscopy-related complications.

An accompanying commentary questions screening strategies for older patients, asserting that those with shorter life expectancies "have less time to develop clinically significant cancers after a screening test and are more likely to die from non-cancer health problems after a cancer diagnosis." Additionally, it adds, "Older persons face a higher risk of complications from procedures such as screening colonoscopy."

Jim Burger

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