Study Supports Routine Colon Cancer Screening Through Age 75, With Individualized Decisions Afterwards Interview with:

Xabier Garcia-De-Albeniz MD PhD Research Associate Department of Epidemiology Mongan Institute for Health Policy, Massachusetts General Hospital. Board Member, GEMCAD. Member, Group for Cancer Prevention, SEOM

Dr. Xabier Garcia-De-Albeniz

Xabier Garcia-De-Albeniz MD PhD
Research Associate
Department of Epidemiology
Harvard T.H. Chan School of Public Health
Mongan Institute for Health Policy
Massachusetts General Hospital What is the background for this study?

Response: Randomized controlled trials are considered the gold standard to inform health care delivery. Unfortunately, no randomized controlled trials of screening colonoscopy have been completed. Ongoing trials exclude persons aged 75 or older, and will not have mature results before 2025. However, healthy persons older than 75 may live long enough to benefit from colorectal cancer (CRC) screening. The Medicare program reimburses screening colonoscopy without an upper age limit since the year 2001. We used the extensive experience of Medicare beneficiaries to evaluate the effectiveness and safety of screening colonoscopy. What are the main findings?

Response: We estimated that screening colonoscopy reduced the 8-year risk for colorectal cancer from approximately 2.6% to 2.2% in beneficiaries aged 70 to 74 and from 3.0% to 2.8% in those aged 75 to 79 years. The excess risk for serious adverse events after colonoscopy was small, especially among younger beneficiaries. We also showed that those cancers diagnosed with a screening colonoscopy have lower stages than those diagnosed by other means. As opposed to other screening tests (e.g. mammogram) that detect cancers at earlier stages, screening colonoscopy also *prevents* cancer (by removing polyps, precancerous lesions). What should readers take away from your report?

Response: Our findings are consistent with the USPSTF recommendations for routine screening through age 75, followed by individualized decisions afterward. Because the ongoing trials do not include the older age groups, our study provides helpful information for benefit–risk analyses. Our estimates of the effect of screening colonoscopy on colorectal cancer incidence and complication rates in older persons are particularly important in view of current policies to increase screening uptake: The Healthy People 2020 goal is a 70% CRC screening rate. What recommendations do you have for future research as a result of this study?

Response: Future research will have to focus on identifying those individuals that will benefit most from screening. To identify them, researchers will have to explore different patients characteristics, like family history, sociodemographic characteristics, genetic susceptibility and so on. Future research will also have to study the optimal intervals between screening tests according to previous findings. Is there anything else you would like to add?

Response: This has been a collaborative project between the Harvard T.H. Chan School of Public Health, Harvard Medical School, Massachusetts General Hospital and the University of Oslo, supported by NIH and AHRQ. Thank you for your contribution to the community.


García-Albéniz X, Hsu J, Bretthauer M, Hernán MA. Effectiveness of Screening Colonoscopy to Prevent Colorectal Cancer Among Medicare Beneficiaries Aged 70 to 79 Years: A Prospective Observational Study. Ann Intern Med. [Epub ahead of print 27 September 2016] doi:10.7326/M16-0758

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