CHAPEL HILL, N.C.—A new study of U.S. veterans ages 70 and older finds that the healthiest get the most benefit from current colon cancer screening methods. However, for many less healthy veterans the burdens of screening may outweigh the benefits.
“This study shows that we really need to target screening in older adults, so that those who will benefit do get screened and followed-up while those who won’t benefit aren’t exposed to unnecessary burdens,” said Christine E. Kistler, MD, assistant professor of Family Medicine at the University of North Carolina at Chapel Hill and lead author of the study.
The study was published online last month by the journal Archives of Internal Medicine. Kistler led the study while completing a geriatrics fellowship at the University of California, San Francisco and the San Francisco Veterans Affairs Medical Center. She has since joined the faculty at the UNC School of Medicine.
In the study, 212 patients ages 70 and older who were treated at four Veterans Affairs medical facilities were followed for seven years after receiving a positive result in a fecal occult blood test (FOBT). The test, which determines whether or not occult (hidden) blood is present in the stool, is the most common method used in the VA health system as an initial screen for colon cancer. A follow-up colonoscopy within one year is recommended for patients with a positive FOBT.
The study found that a little more than half of the patients received a follow-up colonoscopy. Among those who did, more than 25 percent were found to have significant disease such as precancerous adenomas or cancer, were treated, and survived for more than five years. However, 59 percent of those who received follow-up colonoscopy did not have cancer, 16 percent died of other causes within 5 years, and 10 percent suffered complications from either colonoscopy or cancer treatment.