COLON CANCER SCREENING AMONG US ADULTS AGED 65 AND OLDER: THE INFLUENCE OF LIFE EXPECTANCY AND AGE

Wednesday, October 22, 2014
Poster Board # PS4-23

Mara A. Schonberg, MD, MPH, Beth Israel Deaconess Medical Center, Brookline, MA, Keith Bellizzi, PhD, MPH, University of Connecticut, Storrs, CT, Erica Breslau, PhD, National Cancer Institute, Bethesda, MD and Ellen P. McCarthy, PhD, MPH, Division of General Medicine and Primary Care, Brookline, MA
Purpose: Several organizations changed their guidelines in 2008 and now recommend that adults with less than 10 year life expectancy cease to undergo colorectal (CRC) cancer screening while other organizations recommend ceasing CRC screening in adults >75 years.  Therefore, we aimed to examine receipt of CRC screening by life expectancy (LE) and age among adults >65 years.

Method:

We performed a cross-sectional survey of community dwelling US adults >65 years that participated in the 2008 or 2010 National Health Interview Survey. We categorized participants according to estimated life expectancy (LE, >9-years, <9-years) using a validated index. We examined reported receipt of CRC screening by LE and age adjusting for sociodemographic characteristics and access to care.

Result:

Sample characteristics differed by less than 5% between 2008 (n=3,790) and 2010 (n=4,099).  Overall, 55.4% of the sample was female; 38.6% had <9 years LE; 33.5% were aged 75-84 and 11.4% were >85 years.  Reported receipt of CRC screening increased between 2008 (34.3%) and 2010 (59.0%, p<0.001).  Among participants that reported being screened, 72.9% reported being screened with colonoscopy in the past 10 years in 2008 compared to 92.4% in 2010, p<0.001. Adults >85 years were less likely to be screened than adults 65-74 years in both 2008 (35.2% vs. 28.1%, p=0.04) and 2010 (62.3% vs. 40.6%, p<0.001) but differences were greater in 2010. Adults with <9 year LE tended to be less likely to be screened in 2008 (32.2 of those with < 9 year LE were screened vs. 35.9% of those with >9 year LE, p=0.06) but were significantly less likely to be screened in 2010 (54.0% of those with < 9 year LE were screened vs. 62.2%of those with >9-year LE, p<0.001). Results were similar in multivariable analyses.

Conclusion:

While patient age and life expectancy are increasingly being considered in decision-making around CRC screening, receipt of CRC screening is rising among older adults regardless of their age or life expectancy. Interventions are needed to better target CRC to older adults by life expectancy.

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