Excessive cancer screening in the elderly
Based on the National Health Interview Survey, researchers at the University of Connecticut have reported that patients ≥75 years of age continue to undergo cancer screening in spite of unproven benefit. Specifically, 57%, 62%, 53%, and 56% of patients 75-79 years of age have colorectal, breast, cervical, and prostate screening, respectively. More than 50% of patients > 75 years of age undergo cancer screening based on physician recommendations.
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From MNT blog:
U.S. Preventive Services Task Force guidelines recommend against routinecancer screening, especially for breast, cervical, colorectal and prostate cancer, but adults 75 and older are still receiving regular cancer screenings. The report published in the December 12/26 issue of Archives of Internal Medicine, one of the JAMA/Archives journals, is a part of the journal's Less is More series, the aim is to educate healthcare professionals and patients alike in cuttings costs, but having a better service at the same time.
The authors write as background information in the article :
The authors write as background information in the article :
"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 ...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, to estimate 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 and older.
Percentages of those reporting cancer screenings are as follows :
- 62 percent Women age 75 to 79 - A mammogram within the past two years.
- 50 percent of women age 80 and older - A mammogram within the past two years.
- 53 percent of women ages 75 to 79 - A Papanicolaou screen (also known as a pap smear or pap test) for cervical cancer within the past three years.
- 38 percent of women ages 80 and older - A pap smear within the past three years.
- 57 percent highest of men and women 75 to 79 - Screenings for colorectal cancer.
- 57 percent of Men 75-79 - Prostate cancer screening.
- 42 percent of Men 80 and older - Prostate cancer screening.
- 40 percent of Men 50-74 and older - Prostate cancer screening
Individuals without a high school diploma were significantly less likely to be screened for breast, cervical and prostate cancer, compared with adults older than 75 years with a college degree. Adults older than 75 years were also significantly more likely to be screened for breast, colorectal, and prostate cancer if a physician recommended the test.
The authors concluded :
"A high percentage of older adults continue to be screened in the face of ambiguity of recommendations for this group ... 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."
In additional commentary, Louise C. Walter, M.D., of the University of California, San Francisco and San Francisco Veterans Affairs 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 ...
Still, the data by Bellizzi et al raise the issue of whether quality measures should address the overuse of cancer screening."
Dr. Walter concludes :
"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 ...Written by Rupert Shepherd
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."
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