A “Green Banana” Worth Buying in Older Age: Colorectal Cancer Screening for Persons Older Than 75 Years Without Previous Screening
Authors: Amanda V. Clark, C. Seth Landefeld
Journal: Annals of Internal Medicine (2014)

Editorials3 June 2014A “Green Banana” Worth Buying in Older Age: Colorectal Cancer Screening for Persons Older Than 75 Years Without Previous ScreeningAmanda V. Clark, MD and C. Seth Landefeld, MDAmanda V. Clark, MDFrom Tinsley Harrison Residency Training Program, University of Alabama at Birmingham, Birmingham, Alabama; and University of Alabama at Birmingham, Birmingham, Alabama.Search for more papers by this author and C. Seth Landefeld, MDFrom Tinsley Harrison Residency Training Program, University of Alabama at Birmingham, Birmingham, Alabama; and University of Alabama at Birmingham, Birmingham, Alabama.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M14-0869 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Many older persons recognize that life is limited: “When you're 83, it's not going to be 20 years,” a patient said (1). Some older persons and their physicians implement pragmatic strategies represented by the sayings “We don't buy green bananas” and “We practice slow medicine” (2). For persons older than 75 years, colorectal cancer screening may be considered an exemplar of the medical “green banana”—it takes years to ripen in terms of preventing death, a time that may seem long when life expectancy may be short. In this issue, van Hees and colleagues (3) provide compelling evidence that many older ...References1. Reuben DB. Medical care for the final years of life: “When you're 83, it's not going to be 20 years.”. JAMA. 2009;302:2686-94. [PMID: 20040557] CrossrefMedlineGoogle Scholar2. McCullough D. My Mother, Your Mother: Embracing “Slow Medicine,” the Compassionate Approach to Caring for Your Aging Loved Ones. New York: Harper Perennial; 2009. Google Scholar3. van Hees F, Habbema JD, Meester RG, Lansdorp-Vogelaar I, van Ballegooijen M, Zauber AG. Should colorectal cancer screening be considered in elderly persons without previous screening? A cost-effectiveness analysis. Ann Intern Med. 2014;160:750-9. LinkGoogle Scholar4. Mandel JS, Bond JH, Church TR, Snover DC, Bradley GM, Schuman LM, et al. Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota Colon Cancer Control Study. N Engl J Med. 1993;328:1365-71. [PMID: 8474513] CrossrefMedlineGoogle Scholar5. Selby JV, Friedman GD, Quesenberry CP, Weiss NS. A case-control study of screening sigmoidoscopy and mortality from colorectal cancer. N Engl J Med. 1992;326:653-7. [PMID: 1736103] CrossrefMedlineGoogle Scholar6. Walter LC, Covinsky KE. Cancer screening in elderly patients: a framework for individualized decision making. JAMA. 2001;285:2750-6. [PMID: 11386931] CrossrefMedlineGoogle Scholar7. U.S. Preventive Services Task Force. Screening for colorectal cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2008;149:627-37. [PMID: 18838716] LinkGoogle Scholar8. Shapiro JA, Klabunde CN, Thompson TD, Nadel MR, Seeff LC, White A. Patterns of colorectal cancer test use, including CT colonography, in the 2010 National Health Interview Survey. Cancer Epidemiol Biomarkers Prev. 2012;21:895-904. [PMID: 22490320] CrossrefMedlineGoogle Scholar9. Arias E. United States life tables, 2009. Natl Vital Stat Rep. 2014;62:1-63. [PMID: 24393483] MedlineGoogle Scholar10. Christensen K, Doblhammer G, Rau R, Vaupel JW. Ageing populations: the challenges ahead. Lancet. 2009;374:1196-208. [PMID: 19801098] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Amanda V. Clark, MD; C. Seth Landefeld, MDAffiliations: From Tinsley Harrison Residency Training Program, University of Alabama at Birmingham, Birmingham, Alabama; and University of Alabama at Birmingham, Birmingham, Alabama.Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-0869.Corresponding Author: C. Seth Landefeld, MD, Chair, Department of Medicine, University of Alabama at Birmingham, Boshell Diabetes Building, Suite 420, 1720 2nd Avenue South, Birmingham, AL 35294-0012; e-mail, sethlandefeld@uab.edu.Current Author Addresses: Dr. Clark: Chief Resident, University of Alabama at Birmingham Internal Medicine Residency Training Program, Boshell Diabetes Building, Suite 327, 1720 2nd Avenue South, Birmingham, AL 35294-0012.Dr. Landefeld: Chair, Department of Medicine, University of Alabama at Birmingham, Boshell Diabetes Building, Suite 420, 1720 2nd Avenue South, Birmingham, AL 35294-0012. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoShould Colorectal Cancer Screening Be Considered in Elderly Persons Without Previous Screening? Frank van Hees , J. Dik F. Habbema , Reinier G. Meester , Iris Lansdorp-Vogelaar , Marjolein van Ballegooijen , and Ann G. Zauber Should Colorectal Cancer Screening Be Considered in Elderly Persons Without Previous Screening? Frank van Hees , J. Dik F. Habbema , Reinier G. Meester , Iris Lansdorp-Vogelaar , Marjolein van Ballegooijen , and Ann G. Zauber Metrics Cited byComparison in the development of colorectal cancer after screening colonoscopy between elderly and younger population 3 June 2014Volume 160, Issue 11Page: 804-805KeywordsCancer screeningCancer treatmentColonoscopyColorectal cancerColorectal cancer screeningHematologic testsLife expectancyPrevention, policy, and public healthQuality adjusted life yearsResidency ePublished: 3 June 2014 Issue Published: 3 June 2014 Copyright & PermissionsCopyright © 2014 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...