Journal of General Internal Medicine

, Volume 26, Issue 12, pp 1441–1449 | Cite as

Assessing the Impact of Screening Colonoscopy on Mortality in the Medicare Population

  • Cary P. Gross
  • Pamela R. Soulos
  • Joseph S. Ross
  • Laura D. Cramer
  • Christopher Guerrero
  • Mary E. Tinetti
  • R. Scott Braithwaite
Original Research



Some have recommended against routine screening for colorectal cancer (CRC) among patients ≥75 years of age, while others have suggested that screening colonoscopy (SC) is less beneficial for women than men. We estimated the expected benefits (decreased mortality from CRC) and harms (SC-related mortality) of SC based on sex, age, and comorbidity.


To stratify older patients according to expected benefits and harms of SC based on sex, age, and comorbidity.


Retrospective study using Medicare claims data.


Medicare beneficiaries 67–94 years old with and without CRC.

Main Measures

Life expectancy, CRC- and colonoscopy-attributable mortality rates across strata of sex, age, and comorbidity, pay-off time (i.e. the minimum time until benefits from SC exceeded harms), and life-years saved for every 100,000 SC.

Key Results

Increasing age and comorbidity were associated with lower CRC-attributable mortality. Due to shorter life expectancy and CRC-attributable mortality, the benefits associated with SC were substantially lower among patients with greater comorbidity. Among men aged 75–79 years with no comorbidity, the number of life-years saved was 459 per 100,000 SC, while men aged 67–69 with ≥3 comorbidities had 81 life-years saved per 100,000 SC. There was no evidence that SC was less effective in women. Among men and women 75–79 with no comorbidity, number of life-years saved was 459 and 509 per 100,000 SC, respectively; among patients with ≥3 comorbidities, there was no benefit for either men or women.


Although the effectiveness of SC was equivalent for men and women, there was substantial variation in SC effectiveness within age groups, arguing against screening recommendations based solely on age.

Key Words

screening colonoscopy colorectal cancer screening medicare 



This study used the linked SEER-Medicare database. The interpretation and reporting of these data are the sole responsibility of the authors. The authors acknowledge the efforts of the Applied Research Program, NCI; the Office of Research, Development and Information, CMS; Information Management Services (IMS), Inc.; and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER-Medicare database.

This work was supported by funding from by the National Institutes of Health (grant number 1 R21 HS017624-01).

Conflict of Interest

None disclosed.


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Copyright information

© Society of General Internal Medicine 2011

Authors and Affiliations

  • Cary P. Gross
    • 1
    • 4
  • Pamela R. Soulos
    • 1
  • Joseph S. Ross
    • 1
  • Laura D. Cramer
    • 1
  • Christopher Guerrero
    • 1
  • Mary E. Tinetti
    • 2
  • R. Scott Braithwaite
    • 3
  1. 1.Yale School of MedicineSection of General Internal MedicineNew HavenUSA
  2. 2.Yale School of MedicineSection of GeriatricsNew HavenUSA
  3. 3.NYU School of Medicine, Division of General MedicineSection on Value and Comparative EffectivenessNew YorkUSA
  4. 4.Yale University School of MedicinePrimary Care CenterNew HavenUSA

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