Better senior health is possible with smarter colorectal screening

Harold Mandel's picture
Colon
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Elderly people generally share deep concerns about a possible increased risk for colorectal cancer. There has been a great deal of research in recent years dealing with dietary factors and exercise in relation to risk factors for colorectal cancer. Clearly, eating more fiber and less red meat along with increased exercise seem to be good ideas for prevention. Another good idea to help effectively confront colorectal cancer is screening.

Researchers decided to explore whether the age based quality measure for screening for colorectal cancer is associated with the overuse of screening in patients who are aged 70-75 in poor health and underuse in those patients who are aged over age 75 in good health, reported the British Medical Journal. The data for this study was taken from electronic data from the Veterans Affairs (VA) Health Care System, which is the largest integrated healthcare system in the United States.

The participants were veterans aged ≥50 who were due for repeat average risk colorectal cancer screening at a primary care visit in 2010. The primary outcome measures included completion of colonoscopy, sigmoidoscopy, or fecal occult blood testing within 24 months of the visit in 2010. Out of 399,067 veterans who met inclusion/exclusion criteria, 38 percent had electronically documented screening within 24 months. It was found that a veteran who was aged 75 and not healthy, and therefore in whom life expectancy might be limited and screening more likely to cause net burden or harm, was significantly more likely to undergo screening than a veteran aged 76 and who was healthy.

It was concluded that the way quality measures are specified can have a significant effect on screening utilization. It appears that screening does not seem to be utilized according to anticipated benefit across the population. It was specifically found that screening is likely being overused in sick patients aged 75 and younger and underused in healthy patients aged over 75.

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It should be noted that an individualized approach to screening for colorectal cancer in patients aged 76-85 is encouraged. It is suggested that future patient centered quality measures will have to incorporate more explicit measures of clinical benefit and ultimately help guide clinical decision making. It is hoped this will help ensure that patients who are likely to benefit from a service will receive it, and that those patients who might incur more harm than benefit are spared unnecessary and costly tests and treatments.

It appears that smarter colorectal screening could improve senior health, reports the University of Michigan. According to the study by investigators at the University of Michigan and the Veterans Affairs Center for Clinical Management Research, screening for colorectal cancer which is based on age alone may contribute to both underuse and overuse of the tests for older patients.

Lead study author Sameer Saini, M.D., who is a research scientist at VA-CCMR and assistant professor of internal medicine at the U-M Health System, has said, “The way quality measures are defined has important implications for how care is delivered.” Saini has gone on to explain that by focusing on age alone we’re not screening everyone who’s likely to benefit. Furthermore, some people who are not likely to benefit are receiving unnecessary screening, such as those afflicted with severe health problems. It is his position that if quality measures were focused on age and health status, instead of age alone, we’d have better outcomes.

I have observed a great deal of concern among elderly people in dealing with the issue of colon cancer. Many elderly people appear very receptive to suggestions to try to exercise regularly and adhere to a healthy diet which is high in fiber and low in red meat, in order to help prevent colon cancer. However, there is sometimes reluctance to go through colon cancer screening.

It appears if patient-centered quality measures focused on clinical benefit rather than age in order to ensure that patients who are likely to benefit from screening receive it, regardless of age, and that those who are likely to incur harm are spared costly care which is not necessary, there could be less hesitation to consider screening when it is carefully explained why the indications are supportive for this.

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