Colon Cancer Screening among Patients Receiving Dialysis in the United States: Are We Choosing Wisely?
The American Society of Nephrology recommends against routine cancer screening among asymptomatic patients receiving maintenance dialysis on the basis of limited survival benefit. To determine the frequency of colorectal cancer screening among patients on dialysis and the extent to which screening tests were targeted toward patients at lower risk of death and higher likelihood of receiving a kidney transplant, we performed a cohort study of 469,574 Medicare beneficiaries ages ≥50 years old who received dialysis between January 1, 2007 and September 30, 2012. We examined colorectal cancer screening tests according to quartiles of risk of mortality and kidney transplant on the basis of multivariable Cox modeling. Over a median follow-up of 1.5 years, 11.6% of patients received a colon cancer screening test (57.9 tests per 1000 person-years). Incidence rates of colonoscopy, flexible sigmoidoscopy, and fecal occult blood test were 27.9, 0.6, and 29.5 per 1000 person-years, respectively. Patients in the lowest quartile of mortality risk were more likely to be screened than those in the highest quartile (hazard ratio, 1.53; 95% confidence interval, 1.49 to 1.57; 65.1 versus 46.4 tests per 1000 person-years, respectively), amounting to a 33% higher rate of testing. Additionally, compared with patients least likely to receive a transplant, patients most likely to receive a transplant were more likely to be screened (hazard ratio, 1.68; 95% confidence interval, 1.64 to 1.73). Colon cancer screening is being targeted toward patients on dialysis at lowest risk of mortality and highest likelihood of transplantation, but absolute rates are high, suggesting overscreening.
Division of Nephrology and.
Christopher A
CA
Carlos
Department of Epidemiology and Biostatistics, University of California, San Francisco, California.
Charles E
CE
McCulloch
Division of Nephrology and.
Chi-Yuan
CY
Hsu
Department of Epidemiology and Biostatistics, University of California, San Francisco, California.
Barbara
B
Grimes
Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia; and.
Meda E
ME
Pavkov
Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia; and.
Nilka R
NR
Burrows
Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
Vahakn B
VB
Shahinian
Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
Rajiv
R
Saran
Division of Nephrology and.
Neil R
NR
Powe
Division of Nephrology and Kirsten.Johansen@ucsf.edu.|Department of Epidemiology and Biostatistics, University of California, San Francisco, California.
Kirsten L
KL
Johansen
D000368:Aged; D015331:Cohort Studies; D003110:Colonic Neoplasms / Q000150:complications / Q000175:diagnosis; D015179:Colorectal Neoplasms / Q000150:complications / Q000175:diagnosis*; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D014481:United States
colon cancer screening; dialysis; hemodialysis