Cancer screenings in older patients with limited life expectancies continue despite their minimal benefits
A substantial number of older patients with limited life expectancy continue to receive routine screenings for prostate, breast, cervical, and colorectal cancer, even though the procedures are not likely to benefit them.
An aim of Healthy People 2020 is to increase the proportion of people who receive cancer screening consistent with US Preventive Services Task Force (USPSTF) evidence-based guidelines. General agreement exists for the idea that routine cancer screening is not likely to benefit patients with limited life expectancy.
The authors examined rates of prostate, breast, cervical, and colorectal cancer screening in patients 65 years or older using data from the National Health Interview Survey from 2000 through 2010. The study included 27,404 participants who were grouped by risk (low to very high) of 9-year mortality. Low mortality risk was defined as less than 25% and very high mortality risk was 75% or more.
In patients with very high mortality risk, 31% to 55% received recent cancer screening, with prostate cancer screening being the most common (55%). Among women who underwent hysterectomy for benign reasons, 34% to 56% underwent a Papanicolaou (Pap) test within the past 3 years. Older age was associated with less screening for all cancers. Patients who were married, had more education, had insurance, or had a usual place for care were more likely to be screened.
"These results raise concerns about overscreening in these individuals, which not only increases health care expenditure but can lead to patient net harm. Creating simple and reliable ways to assess life expectancy in the clinic may allow reduction of unnecessary cancer screening, which can benefit the patient and substantially reduce health care costs," stated the authors of the study. It was led by Trevor J. Royce, MD, MS, University of North Carolina at Chapel Hill, and colleagues and published in JAMA Internal Medicine (2014; doi:10.1001/jamainternmed.2014.3895).
An additional study, also published in JAMA Internal Medicine (2014; doi:10.1001/jamainternmed.2014.3889), modeled the outcomes from more intensive colonoscopy screening than recommended. This study found that the practice is unfavorable for those being screened. In addition, these more frequent screenings are inefficient from a societal perspective.
In a related commentary (2014; doi:10.1001/jamainternmed.2014.3901), Cary P. Gross, MD, of the Yale University School of Medicine in New Haven, Connecticut, wrote, "Cancer screening in the 21st century, however, is losing its luster. Increasing evidence suggests that many modalities of cancer screening may be far less beneficial than first thought.
"It is particularly important to question screening strategies for older persons. Patients with a shorter life expectancy have less time to develop clinically significant cancers after a screening test and are more likely to die from noncancer health problems after a cancer diagnosis,” stated Gross.