“I’M OVER THE AGE OF 75 - I’VE HEARD I DON’T NEED A COLONOSCOPY?”
The answer is more complicated than a simple yes/no….
This question has come to the front because of a recent update in Colorectal Cancer Screening guidelines from the U.S. Preventive Services Task Force, which were updated/published October 2008 in the Annals of Internal Medicine (click here for full article).
Among other things, this guideline recommended against routine screening for adults over the age 0f 75. They state that there is “moderate certainty” to this recommendation.
It is important to understand that this recommendation was clearly couched with terminology. The use of the word “routine” was intentional so as to say ” not every” person over 75. Also, the “Grade C” aspect of their recommendation says in the fineprint “offer or provide this service only if other considerations support the offering or providing the service in an individual patient.”
Unfortunately, some newspapers reported this recommendation in an unclear way, spreading the misinformation that if you are over 75 there is no benefit to having a colonoscopy and you do not need to worry about colon cancer any longer. Some other articles were more clear though….
What should be understood is that EVERY person over 75 MAY NOT benefit from the procedure. MANY do benefit, however.
The critical question is how healthy the person is.
If the person’s health is not that good and they don’t have a 5+ year life-expectancy due to other medical problems, they may not benefit from a colonoscopy.
However, if they are in reasonably good health, and one can anticipate them living another 5 years, they should strongly think about having a colonoscopy to prevent their life from being shortened by colorectal cancer.
The factors that I discuss with someone over the age of 75 who is considering whether or not to have a colonoscopy are:
- How is your overall health? Can we reasonably anticipate you might live at least another 5 years?
- What is the history of longevity in your family? How did that seem to you?
- How long do you hope to live?
- How would you feel about having your life shortened by colorectal cancer - especially if it were preventable?
- If you were to have colon cancer right now, would you want to know about it? What would you do with that information?
- If you had a colonoscopy and we found colon cancer, would you at least consider meeting with a surgeon to talk about having surgery to remove it?
Depending on one’s answers to these question, a more informed decision can be made about whether this person over age 75 should have a colonoscopy….
Although the U.S. Preventive Services Task Force recommendations often strongly influences Medicare (and thus other private insurance companies)’s policies, I don’t see this particular guideline taking away coverage for patients over the age of 75. To do so would clearly be ageist.
Moreover, insurance companies are always looking at the bottom $$$, and being hospitalized for colon cancer, even if you are over age 75, is still costly for them! Just recently the Agency for Healthcare Research and Quality (AHRQ) reported that:
“two thirds of individuals hospitalized for colorectal cancer in 2006 were age 65 and older.. [and that] older patients with colorectal cancer are not specifically hospitalized for cancer treatment, those diagnosed with the disease are likely to be admitted for complications from the cancer, such as intestinal blockage and pneumonia. Colorectal cancer is the third most common cancer for men and women.” The analysis showed “that cancer treatment accounted for about 152,000 hospitalizations in 2006, while treatment for complications totaled about 420,000 hospitalizations the same year.”
BOTTOM-LINE:
Care for a patient over the age of 75 must be individualized.
The word on the street may not always tell the full story….
Talk to a qualified medical professional if you have concerns or questions about your situation.
