Colon cancer screening of little value for some
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The risks of colorectal cancer screening may outweigh the benefits for some patients aged 70 years and older, a group of doctors warn in the journal Gastroenterology.
“Colorectal cancer screening has risks as well as benefits,” Dr. Cynthia W. Ko from the University of Washington, Seattle, told Reuters Health.
“Our goal in doing this analysis is to help patients and health care providers understand the relative risks and benefits of colorectal cancer screening,” Ko said. “Our analysis does show that colorectal cancer screening is unlikely to benefit some patient subgroups—especially those who are older or who have significant comorbidities.”
Dr. Ko and Dr. Amnon Sonnenberg from Oregon Health and Science University, Portland, examined the probability of colorectal cancer screening-related benefits and harms in older patients with varying health status.
Colorectal cancer incidence rates increase with age, the authors note, but the cumulative lifetime odds of dying from colorectal cancer decrease in men and women with advancing age who often have co-morbid illnesses.
Under the assumption that colorectal cancer screening is unlikely to benefit those whose life expectancy is less than five years, the researchers identified four groups that would not benefit from colorectal screening: men 75 to 84 years old with poor health; men 85 years and older with average or poor health; women 80 to 89 years old with poor health; and women 90 years and older with average or poor health.
Even for those likeliest to benefit from colorectal cancer screening, the number who would have to be screened to prevent one colorectal cancer death ranged from 42 (with colonoscopy screening) to 177 (with fecal occult blood test screening) among men aged 70 to 74 years in good health.
The results were similar for women aged 70 to 74 years in good health.
The risk of complications varied with the colorectal cancer screening method, the researchers note. For colonoscopy screening, for example, complications outweigh the potential benefits for women aged 75 to 79 years in poor health, women aged 85 to 89 years in average health, men aged 70 to 74 years in poor health, and men aged 90 to 94 years in good health.
“The decision to pursue screening,” Ko concludes, “should be individualized and should take into account a patient’s life expectancy, comorbidity, and preferences.”
In a commentary, Dr. Carmen Lewis from University of North Carolina, Chapel Hill, says “this information should be used as an aid to help inform patients about the risks and benefits of colon cancer screening and then with their physicians, patients can explore their personal values and make the decision that is right for them.”
SOURCE: Gastroenterology, October 2005.
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