Colonoscopy Done Too Often

With the aim of helping physicians deliver “high-value, cost-conscious health care,” the American College of Physicians updated its guidelines regarding screening for colorectal cancer. The main points, contained in a study in the March 6 edition of Annals of Internal Medicine, are that stool-based tests and flexible sigmoidoscopies be given consideration equal to colonoscopies for patients at average risk, and that patients 75 and older or who have a life expectancy of less than 10 years not be screened at all.

Amir Qaseem, MD, PhD, MHA, senior medical associate at the American College of Physicians and author of the guidelines, says that “there is no evidence that screening more often … will result in improved patient outcomes.” He adds, “There is no one better test than the others. It depends on the medical circumstances and patient preferences. Those are the things that need to be kept in mind.”

The study says that “screening more frequently than recommended can contribute substantially to avoidable health care costs. The benefit of screening is reduced mortality and possibly reduced incidence, whereas the harms include perforation and major bleeding with endoscopic tests and exposure to radiation with radiologic tests.”

The study adds that “colonoscopy is overused in elderly patients, including repeated screening in less than 10-year intervals and routine screening of patients older than 80 years.”

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