Risks outweigh benefits of more frequent colonoscopies in older adults

For adults over 75, the added costs and potential harms for colonoscopy screening beyond the recommended interval of 10 years outweigh the benefits, according to a study published in the August issue of JAMA Internal Medicine.

Frank van Hees, MSc, a scientific researcher with Erasmus University Medical Center’s department of public health in the Netherlands, and colleagues found that more frequent screenings may lead to costly overtreatment and to complications if polypectomies are performed.

The authors noted that one-in-five older adults with no cancer history underwent a colonoscopy every five years, instead of the recommended 10 years. One-in-four adults older than 75 with a negative cancer reading underwent a colonoscopy, despite recommendations against routine screening for those older than 75 who have an adequate screening history.

“[B]oth practices will substantially increase the number of colonoscopies performed and, hence, the number of colonoscopy-related complications experienced,” wrote van Hees and colleagues. “Moreover, continuing screening beyond 75 years might substantially increase overdiagnosis and overtreatment…”

The modeling study, which analyzed statistics derived from Medicare data, found that colonoscopies with polypectomy were associated with an excess risk for complications, while colonoscopies without polypectomy were not. Moreover, the risks associated with colonoscopies with polypectomy increased exponentially with age, according to the authors.

It is important not to do more colonoscopy screening than is needed, wrote van Hees and colleagues, “because both colonoscopy capacity and financial resources are constrained.”

“Screening Medicare beneficiaries more intensively than recommended is not only inefficient from a societal perspective; often it is also unfavorable for those being screened,” they concluded. “This study provides evidence and a clear rationale for clinicians and policy makers to actively discourage this practice.”

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