Wednesday, March 13, 2013

Scoping out colonoscopies

Cheryl Clark @CherClarHealth at HealthLeaders Media posts this thought on Facebook:

I know, the drugs are really really nice. But if you're over 69, beware the colonoscopy without indication. USPSTF says don't get 'em unless you've got a symptom. Maybe there should be a hard stop policy? Colonoscopies can cause harm (perforations, bleeding, false positives, etc.) They also waste resources. In a hospital, they can cost $3,000. in an outpatient setting, $600 or so depending on the region.

Check out this article by Cheryl.  An excerpt:

During the year after an influential U.S. task force advised providers to stop routine screening colonoscopies in seniors over age 75 because risks of harm outweigh benefits, as many as 30% of these "potentially or probably inappropriate" procedures were still being performed, with huge pattern variation across the nation, especially in Texas.

"We found that a large proportion of colonoscopies that are performed in these older patients were potentially inappropriate based on age-based screening guidelines," says Kristin Sheffield, PhD, assistant professor of surgery at the University of Texas Medical Branch at Galveston, lead researcher of the study.

She follows up with this guide from Choosing Wisely.  Excerpts:

Colonoscopy is the most accurate test for cancer of the colon and rectum, proven to detect the disease early and save lives. But even a very good test can be done too often. Here’s when you need it, and when you might not.

Colonoscopy is a safe procedure. But occasionally it can cause heavy bleeding, tears in the colon, inflammation or infection of pouches in the colon known as diverticulitis, severe abdominal pain, and problems in people with heart or blood vessel disease. Some complications can lead to blood transfusions, surgery, hospitalization, or rarely, death. The test also has inconveniences. You have to restrict your diet and take laxatives beforehand. And because the exam requires sedation, someone has to drive you home and you may miss a day of work. So you don’t want to have the test more often than necessary.

Colon cancer screening should begin at age 50 for most people. If a colonoscopy doesn’t find adenomas or cancer and you don’t have risk factors, the next test should be in ten years. If one or two small, low-risk adenomas are removed, the exam should be repeated in five to ten years. Ask your doctor when and how often to have a colonoscopy if you have inflammatory bowel disease; a history of multiple, large, or high-risk adenomas; or a parent, sibling, or child who had colorectal cancer or adenomas. Routine checks usually aren’t needed after age 75.

1 comment:

Thomas Pane said...

Colonoscopies are better at detecting colon cancer than mammograms are at detecting breast cancer.

Colonoscopy is one of the big success stories in medicine, but as noted due to the risk/reward profile should be done with discretion if at all when people reach a certain age.