title: Influence of Age and Comorbidity on Colorectal Cancer Screening in the Elderly.
abstract: Expert recommendations differ for colorectal cancer screening in the elderly. Recent studies suggest that healthy adults aged >75 years may benefit from screening. This study examined screening use and follow-up, and how they varied by health status within age strata, among a large cohort of elderly individuals in community settings.
  
  
  
  A population-based, longitudinal cohort study was conducted among health plan members aged 65-89 years enrolled during 2011-2012 in three integrated healthcare systems participating in the Population-Based Research Optimizing Screening through Personalized Regimens consortium. Comorbidity measurements used the Charlson index. Analyses, conducted in 2015, comprised descriptive statistics and multivariable modeling that estimated age by comorbidity-specific percentages of patients for two outcomes: colorectal cancer screening uptake and follow-up of abnormal fecal blood tests.
  
  
  
  Among 846,267 patients, 72% were up-to-date with colorectal cancer screening. Of patients with a positive fecal blood test, 65% received follow-up colonoscopy within 3 months. Likelihood of being up-to-date and receiving timely follow-up was significantly lower for patients aged ≥76 years than their younger counterparts (p<0.001). Comorbidity was less influential than age and more strongly related to timely follow-up than being up-to-date. In all age groups, considerable numbers of patients with no/low comorbidity were not up-to-date or did not receive timely follow-up.
  
  
  
  In three integrated healthcare systems, many older, relatively healthy patients were not screening up-to-date, and some relatively young, healthy patients did not receive timely follow-up. Findings suggest a need for re-evaluating age-based screening guidelines and improving screening completion among the elderly.
authors.affiliation: Office of Disease Prevention, Office of the Director, NIH, Rockville, Maryland. Electronic address: klabundc@od.nih.gov.
authors.forename: Carrie N
authors.initials: CN
authors.lastname: Klabunde
authors.affiliation: Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Yingye
authors.initials: Y
authors.lastname: Zheng
authors.affiliation: Kaiser Permanente Southern California, Research and Evaluation, Pasadena, California.
authors.forename: Virginia P
authors.initials: VP
authors.lastname: Quinn
authors.affiliation: Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Elisabeth F
authors.initials: EF
authors.lastname: Beaber
authors.affiliation: RAND Corporation, Santa Monica, California.
authors.forename: Carolyn M
authors.initials: CM
authors.lastname: Rutter
authors.affiliation: Departments of Internal Medicine and Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Ethan A
authors.initials: EA
authors.lastname: Halm
authors.affiliation: Group Health Research Institute, Seattle, Washington.
authors.forename: Jessica
authors.initials: J
authors.lastname: Chubak
authors.affiliation: Department of Family Medicine and Community Health and Department of Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Chyke A
authors.initials: CA
authors.lastname: Doubeni
authors.affiliation: Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Haas
authors.affiliation: Group Health Research Institute, Seattle, Washington.
authors.forename: Aruna
authors.initials: A
authors.lastname: Kamineni
authors.affiliation: Department of Medicine, Perelman School of Medicine, University of Pennsylvania and the Center for Health Equity Research and Promotion, Philadelphia VA Medical Center, Philadelphia, Pennsylvania.
authors.forename: Marilyn M
authors.initials: MM
authors.lastname: Schapira
authors.affiliation: Medical Biostatistics Unit, University of Vermont College of Medicine, Burlington, Vermont.
authors.forename: Pamela M
authors.initials: PM
authors.lastname: Vacek
authors.affiliation: Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Garcia
authors.affiliation: Kaiser Permanente Division of Research, Oakland, California.
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Corley
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002140:California; D015331:Cohort Studies; D003113:Colonoscopy / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D015897:Comorbidity / Q000639:trends*; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D009780:Occult Blood