Colonoscopy May Be Overused in Older Adults, Study Finds

Older U.S. adults may get too many colonoscopies, costing Medicare an estimated $500 million a year and putting patients at an increased risk of side effects such as bleeding, researchers found.

About one-quarter of colonoscopies in Medicare recipients ages 70 and older may be inappropriate based on screening guidelines, according to analysis of insurance claims data released yesterday in the journal JAMA Internal Medicine.

The U.S. Preventive Services Task Force, an independent medical advisory group to the government, and the American College of Physicians recommend against routine colon cancer screening after age 75. Colon cancer is a slow-moving disease that can take 10 to 20 years to progress, while colonoscopies to screen for the disease can cause intestinal tears, bleeding and hospitalizations, said Kristin Sheffield, the lead study author. Doctors and patients may not be aware of the potential harms of colonoscopy at an older age, she said.

“Inappropriate colonoscopies involve an unnecessary risk with no added benefit for the older patient,” Sheffield, an assistant professor in the Department of Surgery at the University of Texas Medical Branch in Galveston, said in a telephone interview. “The harms are greater than the expected benefit.”

Colonoscopies, an examination of the large intestine and rectum, can cost $800 to $1,200 each, according to James Goodwin, a senior author of the study. Inappropriate use of the procedure may cost Medicare, the U.S. health program for the elderly and disabled, about $500 million a year, he said in an e-mail.

Texas Cases

Researchers in the study looked at Medicare claims data in Texas and a 5 percent sample from the U.S. from 2000 through 2009. They identified beneficiaries who were 70 years and older who had a colonoscopy from October 2008 through September 2009.

The analysis showed that about 23 percent of colonoscopies performed from 2008 to 2009 in Texas and the U.S. were potentially inappropriate, meaning they were done in people older than called for by screening recommendations or occurred too soon after a previous test yielded negative results. A colonoscopy is usually performed once every 10 years.

In Texas, about 39 percent of colonoscopies performed in patients ages 76 to 85 and 25 percent of those in people 86 and older were potentially inappropriate, the study found.

Cancer Deaths

About 143,000 cases of colon and rectal cancer are expected to be diagnosed this year in the U.S., and an estimated 50,830 patients will die from the disease, according to the National Cancer Institute.

The American College of Gastroenterology, the American Cancer Society, the U.S. Multi-Society Task Force on Colorectal Cancer and the American College of Radiology don’t address age limits for screening, the authors wrote.

The researchers also looked at which doctors were performing the most colonoscopies in Texas over the study and found that they were typically surgeons and graduates of medical schools before 1990.

In a second study released yesterday, researchers from Case Western Reserve University in Cleveland, Ohio, looked at the rate of hospitalization following colonoscopy with anesthesia. They found that while the rate of complications is small, patients who had anesthesia were at a higher risk for aspiration pneumonia, an inflammation of the lungs and airways from breathing in foreign material.

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