Colorectal Cancer Screening Uncommon in Veterans Aged 76-85, Varying Only Slightly by Predicted Life Expectancy
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.
- 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.
- 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.
- Due to a mostly older male study population, results may not be generalizable to older women.
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.