Colorectal cancer screening rates low among veterans aged 76 to 85 years
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Key takeaways:
- Screening prevalence was 9.7% among veterans with a life expectancy of more than 13 years.
- Researchers noted that future research should examine whether screenings in this age group improve health outcomes.
Colorectal cancer screenings were uncommon among veterans aged 76 to 85 years, which suggests healthy older adults with longer life expectancies who could benefit from screenings are not being targeted, according to researchers.
“Guidelines recommend clinicians selectively offer colorectal cancer (CRC) screening to older adults aged 76 to 85 years factoring in a patient’s life expectancy, values, and preferences,” William J. Deardorff, MD, an assistant professor at the University of California, San Francisco School of Medicine, and colleagues wrote in JAMA.
However, they noted prior research suggesting that few adults aged older than 75 years get screened, potentially resulting in missed screens for those in that age group who could benefit.
To assess screening rates, Deardorff and colleagues used a Veteran’s Affairs (VA) sample of 255,000 veterans aged 76 to 85 years who had one or more VA primary care visits in 2018, were due for a CRC screening and were at average CRC risk.
Of the cohort, 8.1% underwent a CRC test, and 6.5% underwent tests considered screenings.
The researchers found the cumulative incidence of CRC screening was:
- 5.5% (95% CI, 5.3%-5.6%) among those with a life expectancy of less than 7 years;
- 6.9% (95% CI, 6.8%-7.1%) among those with a life expectancy of 7 to 13 years; and
- 9.7% (95% CI, 9.3%-10.2%) among those with a life expectancy of more than 13 years.
For veterans aged 76 to 80 years, the incidence of CRC screening was 7% (95% CI, 6.8%-7.3%), 8% (95% CI, 7.9%-8.2%) and 9.9% (95% CI, 9.5%-10.4%) among those with a life expectancy of less than 7 years, 7 to 13 years and more than 13 years, respectively.
Deardorff and colleagues pointed out that although guidelines address life expectancy in screening decisions, “clinicians often do not make use of this information in part because it is often not readily available.”
They suggested that automated electronic health record-embedded life expectancy calculators that identify individuals aged 76 to 85 years with a life expectancy of over 13 years could help determine who would benefit most from shared decision-making regarding CRC screening.
Deardorff and colleagues concluded that future research “should test whether life expectancy-directed CRC screening in those aged 76 to 85 years improves outcomes.”