May 10, 2011

Overuse Of Colon Screening Becoming A Problem

A recent study published in the Archives of Internal Medicine on the number of colon screenings that are performed on the elderly suggests that doctors are ordering repeated tests that many people do not need.

Long known to be one of the most effective and easy screening tests available, colon screening is credited with saving thousands of lives by catching cancer early. The physician uses a thin flexible tube to examine the intestines which can also snip off suspicious-looking growths.

The exam is generally safe, but risks occur more often with older patients including complications from sedation, accidental perforation of the colon and bleeding.

A colon screening is recommended every 10 years if results are negative for those age 50 and above. The study, lead by Dr. James Goodwin, a geriatrician and researcher at University of Texas Medical Branch in Galveston, showed that among those 80 and older, one-third had a repeat exam within seven years of the previous colonoscopy.

Those over 80 is a group that can skip the test altogether if no problems have been spotted before. The US Preventive Services Task Force recommends not screening for most people 76 to 85 "” and says for those older than 85, screening risks outweigh the benefits.

"The older you are, the more likely you are to die from other causes before cancer becomes deadly," Goodwin said. The screening procedure's risks may outweigh its benefits in many elderly patients.

The study included a random national sample of Medicare claims and from more than 200,000 patients over 65 who received colonoscopies between 2001 and 2008. The number of patients in the sample totaled 24,071, all considered at normal risk for colon cancer.

The results suggest most of the repeat exams were unnecessary. Only 27 percent of all study patients with frequent exams had symptoms that might have raised suspicion of cancer. Those symptoms included abdominal pain, change in bowel habits, and weight loss.

Director of cancer screening at the American Cancer Society, Robert Smith, claims some doctors may recommend more frequent colonoscopies because they think 10 year intervals are too risky.

"Some may think, incorrectly, that finding any growths, even non-suspicious polyps, means a repeat exam should be done within less than 10 years," Smith told the Associated Press (AP). Some doctors also order repeat tests "because they want to bring in income."

Besides being risky and costly, screenings performed too frequently make colonoscopy resources less available for people who really need them.

Smith pointed out that while colonoscopies may be overused in the elderly, the exams and other colon cancer screening methods are underused among other groups, including the uninsured, blacks and Hispanics.

The government's Centers for Medicare & Medicaid Services responded to the study, saying they recognize the importance of effective screening as well as "the importance of ensuring Medicare beneficiaries only get screened at appropriate intervals."

Medicare covers the exams every two years for high-risk patients, but if the study results are true, "then we need to further validate the accuracy of our payments," agency spokeswoman Ellen Griffith told AP.

The authors of the study recommend that more attention be paid to colonoscopy screening rates so that this procedure is reserved for those who can really benefit from it. "Early repeated colonoscopies without clear indication compose a substantial proportion of the present endoscopist workload and also represents substantial Medicare expenditure."

"Given the increasing public interest in and ownership of cancer screening, public information campaigns that emphasize both the necessity for colorectal cancer screening as well as the dangers of overuse may prove beneficial in reducing overuse."


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