Many Colonoscopies for Older Adults May be Inappropriate

April 11, 2013
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ImageA study by Kristin M. Sheffield, Ph.D., and colleagues of the University of Texas Medical Branch, Galveston, that analyzed Medicare claims data for Texas and a sample from the United States suggests that many colonoscopies performed in older patients may be potentially inappropriate.

ImageA study by Kristin M. Sheffield, Ph.D., and colleagues of the University of Texas Medical Branch, Galveston, that analyzed Medicare claims data for Texas and a sample from the United States suggests that many colonoscopies performed in older patients may be potentially inappropriate.

The study background highlights increasing evidence of overuse of the procedure and that some Medicare patients with negative findings at screening colonoscopy may be undergoing another screening too early.

The study results suggest that 23.4 percent of colonoscopies performed in Medicare beneficiaries 70 years and older in 2008-2009 in Texas and across the country were potentially inappropriate according to age-based screening recommendations or the results of a previous screening.

The rate of inappropriateness by age broke down as follows 9.9% for those 70 to 75; 38.8% for those 76 to 85, and 24.9% for those 86 years or older. 

The colonoscopists with percentages significantly above the mean were more likely to be surgeons, graduates of US medical schools, medical school graduates before 1990, and higher-volume colonoscopists.

The likelihood of undergoing potentially inappropriate colonoscopy depends in part on where patients live and what physician they see. 

“Inappropriate use of colonoscopy involves unnecessary risk for older patients and consumes resources that could be used more effectively,” the study concludes.

I think the most telling part is the variation by physician. Notice surgeons have higher rates. Why? They want potential surgeries. Graduates of US medical schools have higher rates. Why? It is the culture of medicine in the US to test, test, test. Older med school graduates have higher rates because newer thinking challenges all the testing. And, of course, those who make their living performing colonoscopies perform more. No surprise.

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It is a personal choice for you. I had one at 50 and am due at 60. I will do it. The thinking is that as you get older, perhaps there is less that you can do if you find something. In any case, ask your physician whether it is for your own care or that of a loved one.  

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