The balance among benefits, burden, and harm was unfavorable in almost every scenario tested, outside the recommended screening scenario. For example, "when a screening interval of 5 instead of 10 years was applied, the gain in quality of life by preventing additional life-years with colorectal cancer care was exceeded by the loss of quality of life due to additional colonoscopies and additional complications."
Similarly, when colonoscopy was continued to age 85 years instead of ceasing at age 75 years, "the overall loss of quality of life exceeded the associated increase in life-years gained." Harms were even greater when colonoscopy was continued to age 95 years or when the screening interval was reduced to 3 years. "This study provides strong evidence and a clear rationale for clinicians and policy makers to actively discourage this practice," Dr. van Hees and his associates said (JAMA Intern. Med. 2014 Aug. 18 [doi:10.1001/jamainternmed.2014.3889]).
Rather than emphasizing the wastefulness of nonrecommended colorectal cancer screening, stressing that such screening negatively affects patient health is more likely to get both physicians and patients to abandon it. Both physicians and patients should be reminded that "one simple screen" often forces elderly or frail patients with many comorbidities onto a track of continued surveillance, biopsies, and removal of lesions that are unlikely to cause harm, with the attendant complications, the investigators added.