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Elderly Should Get Colon Cancer Test, Expert Says

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WebMD Health News

May 5, 2000 (Boston) -- Colon cancer, the second leading cause of cancer-related deaths in the U.S., continues to stalk people well into their so-called golden years, says a Vanderbilt University expert who wants Medicare to pay for colon cancer screening up to age 84.

Cancer experts consider colonoscopy the best tool to screen for colon cancer. But Medicare won?t pay for colonoscopy to screen for colon cancer, says Robert S. Dittus, MD, a professor of medicine at Vanderbilt, in Nashville.

Colonoscopy uses a small device called an endoscope that allows a physician to inspect the walls of the colon. Using the flexible scope, a physician can find small growths, called polyps, which may develop into cancer. By threading tiny instruments into the scope, the doctor can remove these small growths so they can be biopsied.

Colon cancer experts now recommend that everyone have a one-time colonoscopy at around age 50 to determine whether the colon is healthy. But in a new study, presented at a meeting of the Society of General Internal Medicine here, Dittus found that this one-time procedure can be very effective even when done on people in their late 70s or early 80s.

"Colonoscopy continues to save lives even at an advanced age," he tells WebMD. But many elderly people don?t get the procedure because Medicare doesn?t pay for screening colonoscopy, which costs about $350. This is a mistake, Dittus says.

He used a sophisticated computerized model to predict how many lives could be saved by colonoscopies up to age 90. The model predicts the effect of the screening on 100,000 people who had never before had colonoscopies. At age 65, "with screening there would be 360 deaths from colon cancer in the sample, and without screening there would be 2,072 deaths from colon cancer," he says. At age 80, the screening would reduce the overall incidence of colorectal cancer by 3.14%, he says.

Screening up to age 84 costs less than $20,000 per quality-adjusted life year, comparable to the costs associated with breast cancer screening, Dittus tells WebMD. A quality-adjusted life year is a year of life adjusted for its quality; a year of perfect health would equal one quality-adjusted life year.

There is an ongoing debate among experts about the need for various cancer screenings in the elderly. Colon cancer is a focus of this disagreement, Dittus says. "Right now I think most people would say that screening is too costly and probably ineffective after age 70. These data dispute that belief."

But another researcher at the same meeting argued that colon cancer screening is not effective after age 80.

Scott Rich, MD, MPH, from Dartmouth Medical School, based his findings on the effect of another colon cancer screening tool: fecal occult blood (FOB) test. In this test, a sample of feces is examined for traces of blood that can?t otherwise be seen, a sign that cancer may be present in the colon. Rich calculated the days of life that would be lost if screening were halted.

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