Study Finds Colonoscopy Screening Overused in Medicare Beneficiaries | NCI Cancer Bulletin for May 17, 2011 - National Cancer Institute

Study Finds Colonoscopy Screening Overused in Medicare Beneficiaries

A new study suggests that almost one-quarter of Medicare beneficiaries undergo colorectal cancer screening with colonoscopy more frequently than is recommended, including a large number of beneficiaries 80 years of age or older. Performing potentially unnecessary colonoscopies in such elderly beneficiaries is of “special concern” because the risks associated with the procedure (such as intestinal perforations and infections) can often outweigh the benefits for this age group, the study authors noted.

Dr. James Goodwin of the University of Texas Medical Branch, Galveston, and his colleagues published their findings online May 9 in the Archives of Internal Medicine.

Previous studies have documented the underuse of colorectal cancer screening in general, but this study examined whether colonoscopy was being overused in certain populations based on current recommendations. After a negative result on a screening colonoscopy, cancer organizations and public health groups almost uniformly recommend that most people not have a repeat screening colonoscopy for another 10 years.

For this recent study, the researchers analyzed claims and enrollment data from a random sample of Medicare beneficiaries between 2000 and 2008. The analysis included adjustments to identify initial and repeat screening colonoscopies, since these procedures often are not coded as such on Medicare claims, the study authors noted.

Approximately 46 percent of the more than 24,000 Medicare beneficiaries who had a negative result on the initial screening colonoscopy between 2001 and 2003 underwent another colonoscopy sometime in the next 7 years. In this group, nearly 43 percent had “no clear indication for the early repeated examination,” the researchers found, suggesting that the colonoscopies were screening procedures.

A third of people who were 80 years of age or older at their initial negative screening had what appeared to be another screening colonoscopy within 7 years. The analysis revealed “inflection points with noticeable increases in the rate of repeated colonoscopies at 3 and 5 years, suggesting that those procedures might have been routinely scheduled rather than in response to symptoms.”

Limiting inappropriate or medically unnecessary colonoscopies is important for a number of reasons, the researchers wrote. Apart from exposing patients to unnecessary risks and incurring extra costs, they continued, unnecessary colonoscopies tie up resources that could otherwise be used “to increase appropriate colonoscopy in inadequately screened populations.”

NCI Cancer Bulletin for May 17, 2011 - National Cancer Institute