Many health experts agree that certain groups of individuals need to consider getting a colonoscopy, especially those with a family history of colon cancer. Regular screening for the disease could prevent as many as 90 percent of colon cancer deaths each year. Patients should schedule a colonoscopy when the benefits of extending life by preventing cancer outweigh the risks of the screening itself. According to ABC News, however, a recent study found that many older Americans are unnecessarily putting themselves at risk.
Screening colonoscopies are generally recommended for individuals over age 50, which is the group most at risk for cancer. Colon screening can detect precancerous polyps before they develop into cancers, and removing the polyps keeps them from becoming malignant. This procedure, however, can lead to bleeding, infection and perforation of the colon. Medical guidelines recommend that patients undergo a colonoscopy every 10 years after the age of 50, but a study that recently appeared in the JAMA Internal Medicine journal suggests that the elderly overuse colonoscopies.
University of Texas researchers analyzed nine years of Medicare claims data for all patients 70 and older in Texas, and a sample in the United States. They found 23.5 percent of colonoscopies may have been unnecessary based on the frequency or the patient’s age. Nearly half of patients with negative colonoscopies had another in less seven years, often within three or five years. About 25 percent of these screenings took place without any clear medical reason.
Based on this latest study, the U.S. Preventative Services Task Force guidelines recommend that people at average risk of colon cancer should have a colonoscopy once a decade starting at age 50 and stop at age 75. Colon cancer usually progresses slowly, so people near the end of their lives are unlikely to live longer with early detection and treatment.
However, some experts, especially gastroenterologists, say that life expectancy shouldn’t be a fact and argue that the American Cancer Society doesn’t endorse an age limit. Scott Goldstein, director of colon and rectal surgery at Thomas Jefferson University, explains that if he had a patient over 75 who is healthy, he would still screen them, as the chance of getting colorectal cancer continues to increase with age.
The new study acknowledged that doctors may disagree with the guidelines and cite reasons for colonoscopy overuse to include poor communication between doctors and financial incentives. Inappropriate use of colonoscopy involves unnecessary risk for older patients and consumes resources that could be used more effectively. Dr. James Goodwin, a geriatrician at the University of Texas Medical Branch who led much of the research, explains that older patients often don’t reap the benefits of screening and they instead often experience complications such as diarrhea and constipation for weeks as they prep for the colonoscopy: “It’s not death, it’s not hospitalization, but it’s feeling sick and humiliated and helpless. That’s a big price.”