CHICAGO (AP) — Many older Americans get repeat colon cancer tests they don't need and Medicare is paying for it, suggests a study that spotlights unnecessary risks to the elderly and a waste of money.
Almost half of the Medicare patients in the study
had had a colonoscopy less than seven years after getting normal results from
an earlier test. The test is recommended just every 10 years, starting at age
50, for people at average risk whose initial test is normal.
The study showed that among those 80 and older,
one-third had a repeat exam within seven years of the previous colonoscopy.
That's an age group that can skip the test altogether if no problems have been
spotted before.
The U.S. Preventive Services Task Force recommends
against routine colon cancer screening for most people 76 to 85 — and says for
those older than 85, screening risks outweigh the benefits.
The older you are, the more likely you are to die
from other causes before cancer becomes deadly, which means the screening
procedure's risks may outweigh its benefits in many aged patients, the study
authors said.
"I was surprised by the magnitude of the
issue," said lead author Dr. James Goodwin, a geriatrician and researcher
at University of Texas Medical Branch in Galveston.
In the study, researchers chose a random national
sample of Medicare claims and enrollment data from more than 200,000 patients
over 65 who received colonoscopies between 2001 and 2008. The number of
patients in the sample totaled 24,071 — all people considered at normal risk
for colon cancer.
The results suggest most of the repeat exams were unnecessary;
only 27 percent of all study patients with frequent exams had symptoms that
might have raised suspicion of cancer, including abdominal pain, change in
bowel habits, and weight loss. The study appears in Monday's Archives of
Internal Medicine.
The colonoscopy is considered one of the most
effective screening tests available, and it's credited with saving thousands of
lives by catching cancer early. The doctor uses a thin flexible tube to examine
the intestines. It can snip off suspicious-looking growths.
The exam is generally pretty safe, but does have
risks that occur more often with older patients, including complications from
sedation, accidental perforation of the colon and bleeding.
Medicare covers colonoscopies every 10 years — more
frequently for high-risk patients, including those with a family history of
colon cancer. But in this study, the authors excluded high-risk patients.
Colonoscopy costs vary widely but typically exceed
$1,000. While Medicare rules say the government won't pay for too-frequent
colonoscopies, only 2 percent of the study claims were denied for repeat exams
in people without symptoms.
The results suggest the Medicare regulation
"is not working," Goodwin said.
Excessive colonoscopies are not just economically
costly, he said, noting they can pose a real harm to patients, especially older
ones.
Robert Smith, director of cancer screening at the
American Cancer Society, said some doctors may recommend more frequent
colonoscopies because they think 10-year intervals are too risky. Some may
think, incorrectly, that finding any growths, even non-suspicious polyps, means
a repeat exam should be done within less than 10 years, Smith said.
Some doctors also order repeat tests "because
they want to bring in income," he said.
Besides being risky and costly, too-frequent
screenings make colonoscopy resources less available for people who really need
them, Smith said.
But, he pointed out, while colonoscopies may be
overused in the elderly, the exams and other colon cancer screening methods are
underused among some groups, including the uninsured, blacks and Hispanics.
The government's Centers for Medicare &
Medicaid Services issued a statement in response to the study, saying the
agency recognizes the importance of effective screening as well as "the
importance of ensuring Medicare beneficiaries only get screened at appropriate
intervals."
Medicare covers the exams every two years for
high-risk patients, but if the study results are true, "then we need to
further validate the accuracy of our payments," said agency spokeswoman
Ellen Griffith.
Copyright 2011 The Associated Press.
