Americans May Be Having Too Many Colonoscopies

Colonoscopies can help to detect early signs of colon cancer. However, recent findings published in the Journal of General Internal Medicine show that many Americans are undergoing too many . Furthermore, healthy Americans who undergo this sometimes uncomfortable procedure often have repeated examinations long before they actually should.

Current national guidelines strongly recommend that adults aged 50 and older should be screened every ten years, while surveillance colonoscopies should be performed more frequently in adults with pre-cancerous polyps called adenomas or pre-existing gastrointestinal conditions. 

For their findings, researchers used health record data on 1,429 adults between the ages of 50 to 65 years old who underwent an intial colonscopy for cancer screening between 2001 and 2010.

Subsequent exams were done in 871 cases on average six years after the intial procedures. 

Findings revealed that 88 percent of the follow-up screening colonscopies and one in every two surveillance colonoscopies (49 percent) were done earlier than guidelines recommend. People who had no signs of abnormal growths such as polyps the first time around were again examined on average 6.9 years later. Cases where benign polyps (non-adenomas) were found were re-examined on average 5.9 years later.

In other words, this means that patients enrolled in a screening program from the age of 50 to 74 years actually undergo one additional colonscopy in their lifetime compared to the recommended guidelines.

The researchers found a strong association between endoscopist recommendations and early follow-up interval for colonoscopy, consistent with prior research indicating many endoscopists do not agree with the follow-up intervals recommended in the guidelines. They therefore advise that healthcare systems consider monitoring follow-up recommendations as an important lever for discussion and potential reduction in overuse of colonoscopy.

"The idea that a large proportion of the 14 million screening colonoscopies performed annually in the US are actually done unnecessarily is especially concerning in light of the 28 million Americans between 50 and 74 who are not up to date in colorectal cancer screening," said lead study author . Gina Kruse of Massachusetts General Hospital, in a news release. "The overused colonoscopies on the patients in this study alone represent a potential excess of over $1 million in health care spending-resources that might benefit those who are overdue for colon cancer screening."