More Intensive Colorectal Cancer Screening than Recommended Often Harmful for Medicare Beneficiaries

Frank van Hees, MSc Researcher, Department of Public Health, Erasmus MC Rotterdam, The NetherlandsMedicalResearch.com Interview with:
Frank van Hees MSc
Erasmus University Medical Center
Rotterdam, the Netherlands

 

Medical Research: What are the main findings of the study?

Answer: Many U.S. elderly are screened for colorectal cancer more frequently than recommended: One in every five elderly with a negative screening colonoscopy result undergoes another screening colonoscopy within 5 years’ time instead of after the recommended 10 years. Moreover, one in every four elderly with a negative screening colonoscopy result at age 75 or older receives yet another screening colonoscopy at an even more advanced age. Our study shows that, in average risk individuals, these practices are not only a waste of scarce health care resources: often they are also associated with a balance among benefits, burden, and harms that is unfavorable for those being screened.

Medical Research: Were any of the findings unexpected?

Answer: We expected that more intensive screening than recommended would be an inefficient use of resources. However, we did not expect that it would often negatively affect the health of those being screened.

Medical Research: What should clinicians and patients take away from your report?

Answer: Clinicians and patients should remember that screening is very effective and cost-effective in reducing the morbidity and mortality caused by colorectal cancer. However, they should also realize that more intensive screening than recommended is not necessarily better. Our study, for example, shows that more intensive colonoscopy screening than recommended in average risk individuals is often harmful and should be discouraged.

Medical Research: What recommendations do you have for future research as a result of this study?

Answer: What is true for screening for colorectal cancer might also be true for surveillance in adenoma patients. The health effects and cost-effectiveness of continuing surveillance up to very advanced age should also be studied.

Citation:

The Appropriateness of More Intensive Colonoscopy Screening Than Recommended in Medicare Beneficiaries: A Modeling Study
van Hees F, Zauber AG, Klabunde CN, Goede S, Lansdorp-Vogelaar I, van Ballegooijen M. The Appropriateness of More Intensive Colonoscopy Screening Than Recommended in Medicare Beneficiaries: A Modeling Study. JAMA Intern Med. Published online August 18, 2014. doi:10.1001/jamainternmed.2014.3889.