‘Sizable minority’ of older adults against guidance to stop CRC screening at age 75 years
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Key takeaways:
- Results showed 60.4% of respondents felt stopping screening after age 75 years was “acceptable” vs. 39.6% who did not.
- The rate of “unacceptable” responses was similar regardless of estimated life expectancy.
Although most older adults supported guidelines to discontinue colon cancer screening after age 75 years, a “sizable minority” did not, regardless of estimated life expectancy, according to a study published in JAMA Network Open.
“Recent professional guidelines have sought to deimplement use of care that generally does not improve patient outcomes and involves unnecessary harms or risks (ie, low-value care),” Laura E. Brotzman, MPH, a doctoral candidate in the department of health behavior and health equity at University of Michigan School of Public Medicine, and colleagues wrote. “One example is guidelines that recommend patients older than 75 years stop getting screened for colon cancer. The benefit-cost tradeoff for such recommendations varies across patients.”
To gauge acceptance of these guidelines among older adults with limited vs. longer life expectancy, Brotzman and colleagues conducted a cross-sectional study using data from module 8 of the 2018 Health and Retirement Study. They included 1,273 respondents (61% women; 31.3% aged 50-59 years; 31% aged 60-69 years) in the analysis. Most respondents (76.1%) had a longer estimated life expectancy, defined as a score of 7 or less on the Lee Index for 10-year mortality, while 23.9% had limited life expectancy ( 8 on the Lee Index).
Results showed 60.4% of respondents felt stopping CRC screening after age 75 years was acceptable, compared with 39.6% who felt this would be somewhat or very unacceptable. Further, researchers reported similar “unacceptable” responses across both longer and limited life expectancy subgroups (39.7% vs. 39.2%, respectively).
Additional data from exploratory logistic regression analyses demonstrated increased acceptability among women with limited life expectancy (OR = 1.89; 95% CI, 1.09-3.26) but decreased acceptability among men.
“While many older adults found guidelines limiting colon cancer screening after 75 years of age to be somewhat or very acceptable, a sizable minority did not, and this finding is consistent across respondents with different life expectancies,” Brotzman and colleagues wrote. “Nevertheless, these data suggest that limited life expectancy does not increase older adults’ acceptance of guidelines that seek to deimplement low-value care, although less healthy individuals are most likely to benefit and/or avoid unnecessary harms by following such guidelines.”
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