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Colon Screenings Don't Follow Guidelines, Study Suggests

VA study shows elderly ill men getting same screenings as healthy folks,,,,

MONDAY, April 6 (HealthDay News) -- Despite clear guidelines recommending that older people undergo a colonoscopy only if they expect to live at least four more years, a new study reveals that seriously ill elderly men in the United States are being screened for colon cancer on par with healthy people.

The finding specifically reflects the experiences of men seeking care from a U.S. Veteran Affairs hospital, but it suggests that screening practices in general might not hone closely to American Cancer Society protocols.

"Basically what we found is that, regardless of an elderly individual's health, the more often he goes to the doctor, the more likely it is he is going to get a colonoscopy, whether or not it's appropriate," said the study's lead author, Dr. Louise C. Walter, from the geriatrics division at the San Francisco Veterans Affairs Medical Center.

"The problem could reflect a larger systems issue, in that, on the one hand, if you're older and well, very likely you're not seeing physicians often and not getting a colonoscopy screening when it could be very beneficial," she added. "On the flip side, when seniors get sick, they have many more medical visits and are more prone to getting a lot of stuff done to them -- including colonoscopies -- that can actually be harmful and distracting from the real problems at hand."

The study is in the April 7 issue of Annals of Internal Medicine.

Current Cancer Society guidelines suggest that after age 50, men and women with an average risk for developing colorectal cancer should be screened to uncover early signs of the disease. Options include a colonoscopy once every 10 years or one of three procedures -- a flexible sigmoidoscopy, a virtual colonoscopy or a double-contrast barium enema procedure -- that should be done every five years. Various yearly stool analyses are also available.

However, health experts point out that elderly people with serious or even terminal illnesses might not derive practical benefit from the identification and treatment of colon cancer, which is why colonoscopies are not recommended if a person's life expectancy is not more than four years.

To gauge adherence to such advice, Walter and her colleagues reviewed the records of 27,068 men, 70 and older, who had been cared for between 2001 and 2002 at four VA centers.

Though only 46 percent of them had been screened for colon cancer during this time, the researchers found some degree of under-screening and over-screening.

For example, 47 percent of men with a life expectancy of more than five years and no serious health complications had been screened, but 41 percent of men with severe illness and less than a five-year life expectancy were also screened.

In fact, the study found, these ill elderly men were just as likely, or even more likely, than their healthy counterparts to be screened for colon cancer if they had visited a VA facility four or more times.

The researchers pointed out that their findings might not reflect the state of affairs outside the VA hospital system, and that some screening procedures might have been performed for reasons other than to identify colon cancer.

But they suggested that more attention be paid to how such screenings are administered among seniors.

"It's not like we're doing too little or too much," Walter said. "But colon cancer screening rates need to be higher in healthy older people and lower in older sicker people. And to achieve that, we have to be more thoughtful about who's getting what and try and target it a little bit better."

Dr. George Chang, an assistant professor of surgical oncology at the University of Texas M.D. Anderson Cancer Center in Houston, said the findings and analysis "certainly make a lot of sense," but he called the situation complex.

"There are a lot of potential explanations for colonoscopy patterns, and not all screenings are conducted for the same reason," he said. "For example, seniors are often tested for anemia -- having a low blood count -- and in that case, a colonoscopy is commonly used as a diagnostic tool to establish that condition, not as a screen for cancer. And this distinction may not be indicated in the data this study used."

"However, I agree in spirit with what the author is saying here," Chang added. "The last thing you want to do is to generally discourage getting a colonoscopy. Overall, the message has to be that screening is important, and we should all encourage it. But it doesn't mean that patients should get screening beyond the time it would be beneficial. And there is no need to have a colonoscopy for someone who does not have a lengthy life expectancy."

More information

The American Cancer Society has more on cancer screening guidelines.

SOURCES: Louise C. Walter, M.D., division of geriatrics, San Francisco Veterans Affairs Medical Center, U.S. Department of Veteran Affairs, San Francisco, and associate professor of medicine, University of California, San Francisco; George Chang, M.D., assistant professor, surgical oncology, University of Texas M.D. Anderson Cancer Center, Houston; April 7, 2009, Annals of Internal Medicine

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