A significant proportion of primary-care physicians (PCPs) would recommend colorectal cancer screening for elderly patients with a severe illness, a recent survey revealed. Although guidelines recommend such screening for persons aged 50 years and older, elderly patients with severe illnesses are unlikely to benefit from early cancer detection and may suffer harm from the screening process.
A total of 1,266 general internal medicine, family practice, and obstetrics-gynecology physicians were given nine clinical scenarios representing patients aged 50, 65, and 80 years who were either healthy with no illness, moderately severely ill (with ischemic cardiomyopathy), or severely ill (with advanced lung cancer). The respondents were then asked which, if any, screening tests they would recommend for a given patient.
For an 80-year-old patient with inoperable non-small cell lung cancer, 25% of the PCPs would recommend colorectal cancer screening. For an 80-year-old person with ischemic cardiomyopathy, 71% of the respondents recommended colorectal cancer screening.
David A. Haggstrom and fellow researchers also reported in Journal of General Internal Medicine that the physicians were more likely to recommend fecal occult blood testing than colonoscopy as the preferred screening modality for a healthy 80-year-old than for healthy 50- or 65-year-old patients (19%, 5%, and 2%, respectively). Obstetrician-gynecologists were the physicians most likely to recommend colorectal cancer screening for the oldest, sickest patients, and physicians working from a full electronic medical record were less likely to recommend screening.