Even though current guidelines advocate colorectal cancer screenings for those with severe illnesses, they may bring little benefit and may actually pose harm, according to a recent study by Yale School of Medicine researchers published in the Archives of Internal Medicine.
The study offers a new approach for assessing who is likely to benefit from a screening so that screening recommendations can be tailored more effectively to individual patients.
First author R. Scott Braithwaite, M.D., and his colleagues developed a new method of evaluating medical screening tests like colonoscopy, called the “payoff time,” which is the minimum amount of time it takes for the benefits from a test to exceed its harms (i.e., its complications and side effects). The method can also be applied to patients of any age and illness.
To estimate the payoff time for using colonoscopy to screen for colorectal cancer, the team focused on two patient groups that included 50-year-old men with HIV, and 60-year-old women with congestive heart failure.
Braithwaite said the payoff time for colorectal cancer screening was as long as five years for 50-year-old men and as long as 2.9 years for 60-year-old women. Because patients with severe congestive heart failure have a life expectancy of less than 2.9 years, they were more likely to be harmed than benefited by colorectal cancer screening, say the researchers, whereas patients with HIV have a life expectancy of greater than five years, so they were likely to benefit from colorectal cancer screening.
“This issue is only becoming increasingly important as pay-for-performance and physician ‘report cards’ encourage clinicians to offer screening to everyone, regardless of individual benefit,” said Braithwaite, assistant professor of medicine at Yale School of Medicine and at the VA Connecticut Healthcare System. “This may have the unintended consequence of harming patients with severe illnesses.”
Braithwaite added that the “cocktail” of therapies that have revolutionized HIV care have increased life expectancy so much that screening guidelines now apply to patients with HIV.
Citation: Archives of Internal Medicine Vol. 167, No. 21 (November 26, 2007)
Source: Yale University
Related stories:
Higher education associated with greater gains in mortality reduction from common cancers
Deaths due to the four most common cancers—lung, colorectal, prostate, and breast—have dropped substantially in the United States from 1993 to 2001 in working-aged individuals. However, not all Americans are equally likely to benefit from those gains. A study published in the July 8 online issue of the
Journal of the National Cancer Institute shows that more highly educated individuals had mortality reductions in nearly all of these cancers, while less educated individuals had a mortality reduction in only one of the cancer types.
Protein thought to promote cancer instead functions as a tumor suppressor
A protein previously thought to promote colorectal cancer instead suppresses the growth of human cancer cells in culture, researchers at UT Southwestern Medical Center have found.
Analysis of cancer incidence, mortality and survival combined reveals encouraging European trends
The first research to look at recent trends in European cancer incidence, mortality and survival together has shown that cancer prevention and management in Europe is moving in the right direction. However, the research reveals that variations between countries in policies for mass screening, access to health care and treatment are reflected in the different cancer rates.
Study evaluates factors associated with racial disparities in colon cancer screening
Blacks and Hispanics appear less likely to undergo colorectal cancer screening than whites because of socioeconomic, health care access and language barriers, according to a report in the June 23 issue of
Archives of Internal Medicine, one of the JAMA/Archives journals. However, other factors may contribute to screening disparities experienced by Asians.
Obese women in Canada are less likely to be screened for cervical cancer
Research in the United States has shown that obese people are less likely than their normal-weight peers to undergo screening for breast, colon and cervical cancer. Raj Padwal, Rebecca Mitchell and Scott Klarenbach, from the University of Alberta's Faculty of Medicine & Dentistry, have undertaken a study to see if this trend is also true in Canada.
Study Finds Benefits to Earlier Colon Cancer Screenings
Patients would benefit by having colon cancer screenings earlier than currently recommended, according to a study by researchers at Columbia University’s Mailman School of Public Health.
Prevalence of pre-cancerous masses in the colon same in patients in their 40s and 50s
The prevalence of pre-cancerous masses in the colon is the same for average-risk patients who are 40 to 49 years of age and those who are 50 to 59 years of age, according to a study published in the current issue of
Gastroenterology, the journal of the American Gastroenterological Association (AGA) Institute. In comparing colonoscopy results by age group, the team of scientists found that in the 40 to 49 age group, 79 patients, or 14 percent, had one or more adenoma or pre-cancerous growth. Similarly, the 50 to 59 age group had 56 patients, or 16 percent, with one or more adenoma.
Family history and screening for colorectal cancer
A new study indicates that African Americans with a family history of colorectal cancer are less likely to be screened than African Americans at average risk for the disease. There is also some evidence to indicate that AA with a family history are less likely to be screened than their white counterparts. The study is published in the July 15, 2008 issue of
Cancer, a peer-reviewed journal of the American Cancer Society.