Since 2001, Medicare has allowed reimbursement for colonoscopy screenings with no maximum patient age. A large-scale, population-based study used data from Medicare beneficiaries to evaluate the effectiveness of colonoscopy screening to prevent colorectal cancer (CRC) in patients aged 70 years or older. The researchers presented the study at the ASCO Annual Meeting

Medicare data from 2004–2012 were evaluated to determine an eight-year risk of CRC, stage at diagnosis, and 30-day risk of adverse events (AEs) among those who were and were not screened with colonoscopy. 

Nearly 1.9 million Medicare beneficiaries were included in the study, and patients were stratified based on age: 70–74 years versus 75–79 years.

The eight-year risk of CRC among those who were screened with a colonoscopy was 2.22% (95% confidence interval [CI] = 2.03–2.41) for the cohort aged 70–74 versus 2.9% (95% CI, 2.65–3.16) for the cohort aged 75–79 years. Among those not screened with a colonoscopy, the eight-year risk of CRC was 2.67% (95% CI, 2.62–2.72) versus 3.06% (95% CI, 3.00¬–3.11), respectively. 

See Table 1 for the proportion of CRC cases among diagnosis stage for both cohorts.

The excess 30-day risk of any AEs requiring hospitalization or a visit to the emergency department was 5.7 AEs per 1,000 individuals (95% CI, 4.6–6.8) among those 70–74 years compared with 10.7 AEs per 1,000 individuals (95% CI, 9.0–12.4) among those 75–79 years. 

The researchers concluded, “Our findings suggest a relevant benefit of screening colonoscopy for the prevention of CRC in beneficiaries aged 70–74 years and a similar benefit in older beneficiaries. The risk of AEs was low but greater among older individuals.”

Table 1. Proportion of CRC Cases
  Screened Not Screened
Stage 0 14,1% 8.0%
Stage 1 37.6% 24.5%
Stage 2 20.2% 26.7%
Stage 3 21.5% 24.0%
Stage 4 6.7% 16.8%
CRC=colorectal cancer