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

Journal of General Internal Medicine volume 26, pages 1441–1449 (2011)Cite this article

Abstract

Background

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.

Objective

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

Design

Retrospective study using Medicare claims data.

Participants

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.

Conclusions

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.

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Acknowledgements

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.

Author information

Authors and Affiliations

  1. Yale School of Medicine, Section of General Internal Medicine, New Haven, CT, USA

    Cary P. Gross MD, Pamela R. Soulos MPH, Joseph S. Ross MD, MHS, Laura D. Cramer PhD & Christopher Guerrero MPH

  2. Yale School of Medicine, Section of Geriatrics, New Haven, CT, USA

    Mary E. Tinetti MD

  3. NYU School of Medicine, Division of General Medicine, Section on Value and Comparative Effectiveness, New York, NY, USA

    R. Scott Braithwaite MD

  4. Yale University School of Medicine, Primary Care Center, 333 Cedar Street, PO Box 208025, New Haven, CT, 06520, USA

    Cary P. Gross MD

Authors
  1. Cary P. Gross MD
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  2. Pamela R. Soulos MPH
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  3. Joseph S. Ross MD, MHS
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  4. Laura D. Cramer PhD
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  5. Christopher Guerrero MPH
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  6. Mary E. Tinetti MD
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  7. R. Scott Braithwaite MD
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Corresponding author

Correspondence to Cary P. Gross MD.

Appendices

Appendix 1

Selection of cancer sample

figure a

Appendix 2

Decision rule figure for sensitivity analysis, assessing life-years saved for patients who had undergone a negative colonoscopy during 10–15 years prior

figure b

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Gross, C.P., Soulos, P.R., Ross, J.S. et al. Assessing the Impact of Screening Colonoscopy on Mortality in the Medicare Population. J GEN INTERN MED 26, 1441–1449 (2011). https://doi.org/10.1007/s11606-011-1816-4

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  • DOI: https://doi.org/10.1007/s11606-011-1816-4

Key Words

  • screening colonoscopy
  • colorectal cancer screening
  • medicare