Colorectal Cancer Screening Uncommon in Veterans Aged 76-85, Varying Only Slightly by Predicted Life Expectancy
BACKGROUND:
Guidelines recommend clinicians selectively offer colorectal cancer (CRC) screening to older adults aged 76-85 years factoring in a patient’s life expectancy, values, and preferences. Previous research suggests few adults aged >75 receive CRC screening, raising concerns that healthy individuals aged >75 years old who may benefit from continued screening are not being screened. Investigators identified Veterans aged 76-85 years old who were enrolled in VA primary care clinics with ≥1 visit in 2018 (n = 630,309), then identified a subset of Veterans due for CRC screening and at average risk for CRC (n = 255,000) for this study. An individual’s life expectancy was calculated using a VA electronic health record-based life expectancy calculator; individuals were then stratified based on life expectancy <7 years (unlikely to benefit from screening), 7-13 years (possible benefit from screening), and >13 years (potential benefit from screening). The primary outcome was completion of any type of CRC screening, excluding tests for non-screening indications. The outcome was assessed using VA and Medicare claims data during a 1-year look-forward period from the 2018 index primary care visit, with a final follow-up date of December 31, 2019.
FINDINGS:
- Among Veterans aged 76-85 years, CRC screening was uncommon and varied only slightly by predicted life expectancy.
- Overall, the cumulative incidence of CRC screening among those with life expectancy of less than 7 years, 7-13 years, and more than 13 years was 6%, 7%, and 10%, respectively.
- For Veterans in the 76 to 80-year-old age group, the cumulative incidence of CRC screening among those with life expectancy of less than 7 years, 7-13 years, and more than 13 years was 7%, 8%, and 10%, respectively.
IMPLICATIONS:
- Results suggest that clinicians may not be selectively targeting CRC screening to a small subset of healthy older adults with long life expectancies, who may benefit from continued screening.
- Future studies should test whether life expectancy-directed CRC screening in those aged 76-85 improves outcomes.
LIMITATIONS:
- Due to a mostly older male study population, results may not be generalizable to older women.
AUTHOR/FUNDING INFORMATION:
All authors are part of the VA San Francisco Healthcare System. This study was partly supported by HSR&D (IIR 15-434).
Deardorff W, Lu K, Jing B, Jeon S, Boscardin WJ, Fung K, and Lee SJ. Research Letter: Frequency of Screening for Colorectal Cancer by Predicted Life Expectancy among Adults 76-85 Years. JAMA. September 7, 2023;e2315820. Online ahead of print.
