29% of patients would continue colorectal cancer screening despite limited benefits

A new study published Dec. 7 in JAMA Network Open found that 29 percent of veterans who underwent recommended screening colonoscopies did not want to stop getting screened despite limited personal benefits. 

For their study, Sameer Saini, MD, associate professor of gastroenterology at the University of Michigan Medical School and a research scientist at the VA Ann Arbor Center for Clinical Management Research, and colleagues surveyed 1,054 veterans who recently had a screening colonoscopy.  

The survey posed a hypothetical scenario explaining current age-based colorectal cancer screening recommendations and how healthcare providers might use risk calculators for life expectancy, colorectal cancer risk and overall benefit of screening to help guide who needs screening, according to the researchers.  

“It is important for us to start thinking about what type of information we are giving patients that is informing or building their mental models about screening. If we were doing our job right, it would not be a surprise to them that screening might not be beneficial across their whole lifespan,” Saini said in a prepared statement

When asked how comfortable they would be with not undergoing screening if they had other serious health problems and their doctor recommended against screening, 29 percent of veterans said they would not be comfortable at all while 13 percent said they would be extremely comfortable. Additionally, 29 percent said they would go against their doctor’s recommendation and continue with screening, according to the researchers.  

More than one-third of participants were hesitant about using age to determine when to stop colorectal cancer screenings. The researchers also observed that participants expressed distrust about the accuracy of life expectancy calculators or colorectal cancer risk calculators. 

“People don’t trust our ability to predict the future. Also, as others have shown, talking about life expectancy can be uncomfortable,” lead author Marc S. Piper, MD, gastroenterologist at Digestive Health Associates and assistant professor of medicine at Michigan State University, said in the statement.  “We need to shift the conversation to talk about the benefits of screening, rather than life expectancy, or we risk turning people off.”  

To move toward more personalized screening recommendations emphasizing cancer prevention, the researchers suggested that physicians should explain to patients benefit changes of colorectal cancer screenings over a lifespan before they get their first screening colonoscopy.