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 Colorectal Cancer Screens For Oldest Seniors Questioned

Prevention may not always be the best form of treatment for some people. A recent study in The Journal of The American Geriatrics Society found a serious discrepancy among elders who undergo colorectal cancer screening—the oldest seniors, who are least likely to benefit, are getting screened while many younger seniors are not tested.
Colorectal cancer is the third-leading cause of cancer deaths in the United States, according to the Centers for Disease Control and Prevention. Fortunately, these tumors usually develop slowly—over a period of 10 to 15 years—and typically begin as a noncancerous tissue growth or benign polyp.
Given the long lag time, a majority of colorectal cancers and deaths can be prevented by screening. In 1998, Medicare began covering colorectal cancer screenings (blood in stool tests, endoscopies, barium enemas) for adults at average risk. In 2001, Medicare expanded coverage to include colonoscopies every 10 years for adults at average risk.
Several organizations, including the American Cancer Society, the U.S. Preventive Services Task Force, and the American College of Radiology, recommend screening in people aged 50 or older.  A consensus had yet to be reached as to what age these screenings should be stopped.
One reason for this discrepancy is that many doctors are uncomfortable talking with their patients about life expectancy.
“It’s easier to order a test than tell patients what would be best,” says lead study author Mara Schonberg, a gerontologist at Harvard Medical School in Boston.
For time-taxed physicians, having this difficult conversation is not always opportune. Rather than handle the emotional hurdles of the patient possibly feeling offended or abandoned, doctors opt for the easier conversation of benefits and risks versus life expectancy, says Schonberg.
The research group collected data on colorectal cancer screening for 7,747 noninstitutionalized adults, aged 65 years and older, who participated in either the 2008 or 2010 National Health Interview Survey, a questionnaire that asks about illness and health behaviors.
More than half of U.S. adults aged 65 and older (58 percent) reported undergoing recent colorectal cancer screenings. Of those screened, 28 percent, representing 4.8 million Americans, were aged 75 and older or had a lifetime expectancy of less than 10 years. This particular subgroup is excluded from most screening guidelines because the chance of harm—bleeding, perforations, cardiovascular and pulmonary events—is greater than the chance of benefit. Additionally, 39 percent of adults aged 65 to 75 with a lifetime expectancy of 10 years or longer, representing 5.6 million Americans, were not recently screened despite the fact that this group is the most likely to benefit.
Schonberg’s team has developed ePrognosis.com, a website calculator that patients and physicians alike can use to estimate life expectancy and better target older adults for colorectal cancer screens.
Jackie Oberst is Provider’s managing editor. Email her at joberst@providermagazine.com or follow her on Twitter, @ProviderMag.
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