Colorectal Cancer Screening in US Seniors Ages 76-84 Years. J Community Health. 2015;40:769-779. [PMID: 25716518 DOI: 10.1007/s10900-015-9998-z]

Colorectal cancer fecal screening test completion after age 74, sources and outcomes in French program

BACKGROUND

Elderly patients aged at least 75 years old (Elderly_75), represent 45% of colorectal cancer (CRC) incidence. As others, the French Colorectal Cancer Screening Program (CRCSP) does not include Elderly_75. To date, there is little evidence to justify stopping screening at 74 years of age.

AIM

To describe CRC fecal screening test completion after age 74, source (CRCSP/Provider ordered) and outcomes of these tests.

METHODS

The study concerned 18704 Elderly_75 residing in eleven French districts (Ain, Doubs, Essonne, Haute-Saone, Hauts-de-Seine, Jura, Seine-Saint-Denis, Territoire-de-Belfort, Val-de-Marne, Val-d’Oise, Yonne), having performed a CRC screening test between January 2008 and December 2017. The tests performed in a circumstance of delayed response to a solicitation (DRS) from the local cancer screening managing center (Managing-Center) were distinguished from the tests non-solicited by the Managing-Center, performed after a recommendation by a General Practitioner (GP) or other provider ordered (RGP). DRS was any test realized by an Elderly_75 following an initial invitation from the Managing-Center with a maximum 24 mo after this invitation. Any Non-DRS test was considered RGP. The outcomes of these tests were described according to the circumstances of test completion.

RESULTS

Of 18995 screening-tests were performed at ages: 75 (83.5%), 76-80 (13.4%) and > 80 (3.1%) years old. Elderly_75 performed the screening test in a circumstance of DRS (71.9%) or RGP (28.1%). The proportion of the tests that could not be analyzed and not restarted was 13.2%. For these unanalyzed tests, the reason was age-related in 78.0% of cases, related to the laboratory’s refusal to analyze the test of people aged ≥ 77. Reported colonoscopy completion rate was 81.3%. For those 575 people with reported colonoscopy, no complication was listed. 18.0% of the 366 Elderly_75 with lesions had no anteriority in the CRCSP. The neoplasia (124 Low-risk-polyps, 159 High-risk-polyps, 13 Unspecified-polyps and 70 CRCs) detection rate was 19.3/1000 Elderly_75 screened and the CRC detection rate was 3.7/1000 Elderly_75 screened.

CONCLUSION

The high rate of colonoscopy completion after a positive test and the high proportion of screened lesions observed suggest that the lengthening of the screening period could allow significant detection of CRC and polyps that occur in Elderly_75 excluded from CRCSP.

Detection of Colorectal Neoplasia in a Cohort Before and After the Change of Fecal Occult Blood Test in a French Colorectal Cancer Screening Program

OBJECTIVE

To estimate the change in the participation rate and the change in neoplasia incidence before and after the change of the Fecal Occult Blood Test (FOBT) in the cohort included in the Colorectal Cancer Screening Program (CRCSP).

METHODS

Cohort of 279,210 people, aged 50-74 years, invited at least once before 2009, to participate in a CRCSP campaign. The participation rate and the cumulative neoplasia incidence were described on 4 campaigns (≤2008, 2009-2010, 2011-2012 and 2013-2014) with a Guaiac FOBT (gFOBT) and a first campaign (2015-2016) with a Fecal Immunochemical Test (FIT). The cumulative incidence was estimated by the actuarial method and its confidence interval by the Greenwood method.

RESULTS

The participation rate decreased from 32.7% (first gFOBT-campaign) to 24.4% (fourth gFOBT-campaign) then, made a significant bound in the FIT-campaign (28.4%; p < 0.001). 35.4% of the 965 high-risk-polyps screened in this cohort were detected in the FIT-campaign. CRC incidence gradually decreased from 0.4 to 0.1/1000 person-years from the first to the fourth gFOBT-campaign before reaching a bound to 0.4/1000 person-years in the FIT-campaign.

CONCLUSION

Although it was still below the minimum European target (45%), the participation rate has increased between the last gFOBT-campaign and FIT-campaign, justifying the impact of promotional campaigns and the acceptance of the new test by people and GPs. A decline in the neoplasia incidence was observed between the initial and the fourth gFOBT-campaign. The change from gFOBT to FIT between the fourth and fifth campaigns, was associated with a significant increase in detection of neoplasia.

Colorectal cancer screening: Using evidence-based guidelines

Colorectal cancer is the third most common cancer diagnosed in men and women. There are multiple options for prevention and early detection. Evidence-based guidelines are available to select the best option based on personal and family history. NPs should utilize these guidelines in clinical practice to select the appropriate screening for their patients.

Influence of Age and Comorbidity on Colorectal Cancer Screening in the Elderly

INTRODUCTION

Expert recommendations differ for colorectal cancer screening in the elderly. Recent studies suggest that healthy adults aged >75 years may benefit from screening. This study examined screening use and follow-up, and how they varied by health status within age strata, among a large cohort of elderly individuals in community settings.

METHODS

A population-based, longitudinal cohort study was conducted among health plan members aged 65-89 years enrolled during 2011-2012 in three integrated healthcare systems participating in the Population-Based Research Optimizing Screening through Personalized Regimens consortium. Comorbidity measurements used the Charlson index. Analyses, conducted in 2015, comprised descriptive statistics and multivariable modeling that estimated age by comorbidity-specific percentages of patients for two outcomes: colorectal cancer screening uptake and follow-up of abnormal fecal blood tests.

RESULTS

Among 846,267 patients, 72% were up-to-date with colorectal cancer screening. Of patients with a positive fecal blood test, 65% received follow-up colonoscopy within 3 months. Likelihood of being up-to-date and receiving timely follow-up was significantly lower for patients aged ≥76 years than their younger counterparts (p<0.001). Comorbidity was less influential than age and more strongly related to timely follow-up than being up-to-date. In all age groups, considerable numbers of patients with no/low comorbidity were not up-to-date or did not receive timely follow-up.

CONCLUSIONS

In three integrated healthcare systems, many older, relatively healthy patients were not screening up-to-date, and some relatively young, healthy patients did not receive timely follow-up. Findings suggest a need for re-evaluating age-based screening guidelines and improving screening completion among the elderly.

Older adults' preferences for colorectal cancer-screening test attributes and test choice

BACKGROUND

Understanding which attributes of colorectal cancer (CRC) screening tests drive older adults' test preferences and choices may help improve decision making surrounding CRC screening in older adults.

MATERIALS AND METHODS

To explore older adults' preferences for CRC-screening test attributes and screening tests, we conducted a survey with a discrete choice experiment (DCE), a directly selected preferred attribute question, and an unlabeled screening test-choice question in 116 cognitively intact adults aged 70-90 years, without a history of CRC or inflammatory bowel disease. Each participant answered ten discrete choice questions presenting two hypothetical tests comprised of four attributes: testing procedure, mortality reduction, test frequency, and complications. DCE responses were used to estimate each participant's most important attribute and to simulate their preferred test among three existing CRC-screening tests. For each individual, we compared the DCE-derived attributes to directly selected attributes, and the DCE-derived preferred test to a directly selected unlabeled test.

RESULTS

Older adults do not overwhelmingly value any one CRC-screening test attribute or prefer one type of CRC-screening test over other tests. However, small absolute DCE-derived preferences for the testing procedure attribute and for sigmoidoscopy-equivalent screening tests were revealed. Neither general health, functional, nor cognitive health status were associated with either an individual's most important attribute or most preferred test choice. The DCE-derived most important attribute was associated with each participant's directly selected unlabeled test choice.

CONCLUSION

Older adults' preferences for CRC-screening tests are not easily predicted. Medical providers should actively explore older adults' preferences for CRC screening, so that they can order a screening test that is concordant with their patients' values. Effective interventions are needed to support complex decision making surrounding CRC screening in older adults.