Author Interviews, BMJ, Cancer Research, University of Michigan / 04.03.2014
Colon Cancer: Improving Determinants of Who Should Be Screened
MedicalResearch.com Interview with:
Sameer Saini MD
Veterans Affairs Center for Clinical Management Research,
VA Ann Arbor Healthcare System
Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
MedicalResearch.com: What are the main findings of the study?
Dr. Saini: The way that quality measures are defined can have important implications for how care is actually delivered. Current colorectal cancer screening quality measures use age to identify screen-eligible patients, encouraging screening in patients between 50 and 75 years of age. But they do not explicitly incorporate health status. In this context, our study had two main findings.
- First, by focusing on age alone, we are not screening everyone who is likely to benefit. Specifically, many healthy people over 75 years of age (who are outside the target age range of the quality measure) may benefit from screening, but the current measure does not encourage screening in this population, leading to low screening use.
- Second, some people who are NOT likely to benefit are being screened unnecessarily, like those with serious health problems. For example, people between ages 70-75 with serious health problems (who have limited life expectancy) are unlikely to benefit from screening, and may even be harmed by it. But the current quality measure encourages screening in such individuals due to their age, yielding relatively high screening rates. If the system focused on age and health status (rather than age alone), screening use would be more aligned with screening benefit, and we would have better health outcomes.