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Too Many Senior Citizens Get Cancer Screening Says JAMA Study

Researchers examined rates of prostate, breast, cervical and colorectal cancer screening in patients 65 or older

Aug. 18, 2014 – A large number of senior citizens with limited life expectancy continue to receive routine screenings for prostate, breast, cervical and colorectal cancer, according to the authors of a study in JAMA Internal Medicine. And, they add, the procedures are unlikely to benefit them.

They found in patients with very high mortality risk, 31 percent to 55 percent received recent cancer screening, with prostate cancer screening being the most common (55 percent).

For women who had a hysterectomy for benign reasons, 34 percent to 56 percent had a Papanicolaou test within the past three years.

The overall screening rates for the study group were

   ►prostate cancer - 64 percent (ranging from 70 percent in individuals with low mortality risk to 55 percent in those with very high mortality risk);

   ►breast cancer - 63 percent (ranging from 74 percent among people with low mortality risk to 38 percent in patients with very high mortality risk);

   ►cervical cancer - 57 percent (ranging from 70 percent among low mortality risk patients to 31 percent in patients with very high mortality risk); and

   ►colorectal cancer - 47 percent (ranging from 51 percent for low-mortality risk patients to 41 percent for patient with very high mortality risk).

 

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They do note there was less screening for prostate and cervical cancers in more recent years compared with 2000. And they acknowledge 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.

The authors, led by Trevor J. Royce, M.D., M.S., University of North Carolina at Chapel Hill, examined rates of prostate, breast, cervical and colorectal cancer screening in patients 65 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 nine-year mortality. Low mortality risk was defined as less than 25 percent and very high mortality risk was 75 percent or more.

“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,” the authors write.

“There is considerable need for further dissemination efforts to educate physicians and patients regarding the existing screening guidelines and potential net harm from screening in individuals with limited life expectancy.”

Background on Screening Guidelines

The authors of the study presented background on current screening guidelines.

“Healthy People 2020, an initiative released by the US Department of Health and Human Services, defined our nation’s current public health priorities in prevention and health promotion. In the context of cancer, Healthy People aims to increase the proportion of individuals who receive screening consistent with the US Preventive Services Task Force (USPSTF)’s evidence-based guidelines.

“These guidelines include not only indications for cancer screening but also cessation of screening for some conditions when there is no evidence for net benefit or when evidence suggests screening may lead to net harm. Healthy People specifically recommends using data from the National Health Interview Survey (NHIS) to quantify progress in achieving these goals.

“There is general agreement that routine cancer screening has little likelihood to result in a net benefit for individuals with limited life expectancy, as reflected in the consistency in existing guidelines. The American Society of Clinical Oncology (ASCO), as part of their Choosing Wisely Campaign, an initiative designed to highlight the misuse of medical tests, recently recommended avoiding prostate-specific antigen (PSA) screening in men who are expected to live fewer than 10 years.

“Similarly, the American Cancer Society (ACS) and the American Urological Association (AUA) also recommend cessation of PSA screening in men with a life expectancy of less than 10 years. For colorectal cancer screening, the American College of Physicians recommends cessation of screening in individualswith less than 10-year life expectancy. Other guidelines in breast and cervical cancers have similarly used life expectancy and/or age12-14 (a crude surrogate for life expectancy) as a parameter for screening cessation. A summary of selected guidelines is presented below. The routine use of cancer screening in these individuals not only has implications for utilization of health care resources in a setting unlikely to result in net benefit but may also cause net patient harm owing to subsequent diagnostic procedures and overtreatment.
 

Summary of Cancer Screening Cessation Criteria in Select Guidelines

Cancer

Organization

Recommendation

Prostate

USPSTF - US Preventive Services Task Force

Recommend against PSA (prostate-specific antigen) based screening for all men

 

ASCO - American Society of Clinical Oncology

<10-y life expectancy

 

ACS - American Cancer Society

<10-y life expectancy

 

AUA - American Urological Association

Age ≥70 y or <10-15 y life expectancy

Breast

USPSTF - US Preventive Services Task Force

Age ≥75 y

 

SBI - Society of Breast Imaging
ACR -
American College of Radiology

< 5-7 y life expectancy

 

CTFPHC - Canadian Task Force on Preventive Health Care

Age ≥75 y

Cervical

USPSTF - US Preventive Services Task Force

Age >65 y, hysterectomy with removal of the cervix, without history of a high-grade precancerous lesion or cervical cancer

 

ACS - American Cancer Society
ASCCP -
American Society for Colposcopy and Cervical Pathology

Age >65 y

 

ASCP - American Society for Clinical Pathology

Hysterectomy

Colorectal

USPSTF - US Preventive Services Task Force

Age >85 y (for ages 76-85 y, recommend individualized decisions)

 

ACP - American College of Physicians

Age >75 y or <10-y life expectancy

Source: JAMA Intern Med. doi:10.1001/jamainternmed.2014.3895. Published online August 18, 2014. Authors: Trevor J. Royce, MD, MS; Laura H. Hendrix, MS; William A. Stokes, MD; Ian M. Allen, MD, MPH; Ronald C. Chen, MD, MPH

 

Source: JAMA Intern Med. Published online August 18, 2014. doi:10.1001/jamainternmed.2014.3895.

 

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