Screening for colorectal cancer based on age alone may contribute to both underuse and overuse of colonoscopy, sigmoidoscopy, and fecal occult blood testing among older people, according to a study by investigators at the University of Michigan and the Veterans Affairs Center for Clinical Management Research (VA-CCMR). The use of simple age cutoffs in quality measures may contribute to underuse of screening in healthy, older people and overuse in unhealthy, older people, Eve Kerr, MD, MPH, Sameer Saini, MD, and colleagues reported recently in BMJ.1
Dr. Kerr, senior study author, is Director of the VA-CCMR and Professor of Internal Medicine, and Dr. Saini is a Research Scientist at VA-CCMR and Assistant Professor of Internal Medicine, both at the University of Michigan Health System, Ann Arbor. The researchers found that an unhealthy 75-year-old, whose life expectancy is estimated at less than 5 years, was significantly more likely to undergo screening than a 76-year-old in good health.
Implications of Quality Measures
“The way quality measures are defined has important implications for how care is delivered,” Dr. Saini said. “By focusing on age alone we’re not screening everyone who’s likely to benefit and some people who are not likely to benefit are being screened unnecessarily. If quality measures focused on age and health status, rather than age alone, we would have better outcomes,” Dr. Saini added.
In elderly patients, life expectancy varies considerably according to health status. A 74-year-old man in excellent health has a life expectancy of almost 15 years. The study suggests the upper age cutoff could unintentionally discourage colorectal cancer screening in healthy, older individuals.
Dr. Kerr said, “Future patient-centered quality measures should focus on clinical benefit rather than age to ensure that patients who are likely to benefit from screening receive it, regardless of age, and that those who are likely to incur harm are spared unnecessary and costly care.” ■
1. Saini SD, Vijan S, Kerr EA, et al: Role of quality measurement in inappropriate use of screening for colorectal cancer. BMJ. February 26, 2014 (early release online).