Excessive Cancer Screening Among Senior Citizens Appears to Challenge Federal Guidelines
Seniors without high school diploma significantly less likely to be screened for breast, cervical and prostate cancer,
compared to those with college degree
Dec. 12, 2011 – Senior citizens always seem to be doing the wrong thing
- tell us to get flu shots, we won't. Tell us to cut back testing, we get more. The latest complaint is that despite federal
guidelines cautioning against routine screening of those age 75 and older for some of the most common cancers, a high percentage of seniors
report they are still getting screened regularly.
The U.S. Preventive Services Task Force recommends against routine screening for breast, cervical, colorectal and
prostate cancer for patients age 75 years and older. The report on how the guidelines are being ignored appears in the December 12/26 issue of
Archives of Internal Medicine, one of the JAMA/Archives journals, as part of the journal's Less is More series.
"In the United States, the number of adults 65 years or older, currently estimated at 36.8 million, is expected to double
by the year 2030. Providing high-quality care to this growing population while attempting to contain costs will pose a significant challenge,"
the authors write as background information in the article.
After decades in which cancer screening
was promoted as an unmitigated good, as the best — perhaps only — way for people to protect themselves from the ravages of a frightening
disease, a pronounced shift is under way. 10/30/11
New Guidelines for Cervical Cancer:
Annual Pap Test Too Often
Annual cancer screening tests urged less and
10/21/11 - Annual cancer tests are
becoming a thing of the past. New guidelines out Wednesday for cervical cancer screening have experts at odds over some things, but they
are united in the view that the common practice of getting a Pap test every year is too often and probably doing more harm than good.
"While a great deal is known about cancer screening behaviors and trends in young and middle-aged adults, less is known
about screening behaviors in older adults from different racial backgrounds."
Keith M. Bellizzi, Ph.D., M.P.H., of the University of Connecticut, Storrs, and colleagues analyzed data from the
National Health Interview Survey, an annual in-person nationwide survey used to track health trends in U.S. citizens. It estimates the
prevalence of cancer screening among older, racially diverse adults.
The study population included 49,575 individuals, 1,697 of whom were 75 to 79 years of age and 2,376 were 80 years of age
Among women, the percent who reported receiving a mammogram with the past two years by age group were –
● Age 75 to 79 – 62%
● Age 80 and older – 50%
The percentage of women who reported undergoing a Papanicolaou screen (also known as a pap smear or pap test) for cervical cancer
within the past three years by age group were -
● Age 75-79 – 53%
● Age 80 and older – 38%
Reported screenings for colorectal cancer in men and women were highest in the 75- to 79-year-old group, with 57 percent
of participants reporting screening.
Among men, prevalence of prostate cancer screening within the past year was highest in the 75- to 79-year-old group (57
percent) followed by the group that was 80 years and older (42 percent) and the 50 to 74-year-old group (40 percent).
Although analysis showed racial differences in breast, colorectal and prostate cancer screening among older adults, the
authors found that these differences were accounted for by low education attainment, with individuals without a high school diploma
significantly less likely to be screened for breast, cervical and prostate cancer, compared with adults older than 75 years with a college
Adults older than 75 years were also significantly more likely to be screened for breast, colorectal, and prostate cancer
if they recalled that a physician recommended the test.
"A high percentage of older adults continue to be screened in the face of ambiguity of recommendations for this group,"
the authors conclude.
"Prevalence results from this study can serve as a benchmark for progress as we move the science of cancer screening in
older, diverse adults forward."
What is the Right Cancer Screening Rate for Older Adults?
In an invited commentary, Louise C. Walter, M.D., of the University of California, San Francisco and San Francisco
Veterans Affairs Administration Medical Center, writes that "there are no quality measures that address appropriate target rates for cancer
screening in persons older than 75 years."
"While at extremes in older age the likelihood of surviving long enough to benefit from potential detection and treatment
of asymptomatic cancer becomes quite small, and the likelihood of harm becomes quite large, irrespective of other factors, Bellizzi et al were
not able to calculate screening rates in subgroups older than 85 years owing to the small number participating in the survey," writes Dr.
"Still, the data by Bellizzi et al raise the issue of whether quality measures should address the overuse of cancer
"While it is useful to determine screening rates among persons in whom screening will likely result in net benefit or net
harm, between these two groups is a large number of older persons in whom screening offers small or uncertain net benefit," Dr. Walter writes.
"For these persons, the decision about whether the potential benefits of screening outweigh the risks is a value judgment
that requires informed decision-making."
"While arguments persists about what is the 'right' rate of cancer screening in older persons, it seems clear that the
rate of informed decision-making should approach 100 percent," she concludes.
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