Colorectal Cancer Screening in Young Patients With Poor Health and Severe Comorbidity

BACKGROUND: Young patients with poor health and a high risk of mortality from comorbid diseases have less chance of deriving a survival benefit from colorectal cancer screening. The aim of this study was to examine the relationship between colorectal cancer screening, self-reported health status, and comorbidity in a cohort of young patients, defined as patients between the ages of 50 and 64 years. METHODS: This was a single-center study conducted at a Veterans Affairs Medical Center from October 1, 1996, to March 30, 2004. Colorectal cancer screening information was obtained from 861 outpatients who completed the 36-Item Short-Form Health Survey (measure of health status) and the Kaplan-Feinstein Index (comorbidity score). Rates of screening were examined by age, physical component summary score, and severity of comorbid illnesses. RESULTS: Of the veterans, 45.9% had undergone screening within 5 years of their index visit. Screening rates were high among patients with moderate (44.9%) and severe (45.8%) comorbidities. When stratified by age group and physical component summary quartile, there was a trend toward increasing screening rates with better health status in the 50- to 54- and 55- to 59-year age groups. In the 60- to 64-year age group, high screening rates for patients with poorer health were observed: physical component summary quartiles 1 and 2, 55.7% and 54.2%, respectively. Fifty-two patients died during the 5-year follow-up; 37 (71.2%) had undergone screening for colorectal cancer. CONCLUSIONS: Young patients with potentially reduced life expectancy are being screened for colorectal cancer at relatively high rates. Comprehensive assessment of health status and comorbidity should guide cancer screening decisions, especially in individuals with reduced life expectancy who may obtain the least benefit from screening.