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Wednesday, December 28, 2011

Excessive Cancer Screening in our Elderly Population

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.


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 : 
"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
Analysis showed large differences in breast, colorectal and prostate cancer screening among older adults, but the authors found that these differences were accounted for by low education.

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 ...

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."
Written by Rupert Shepherd 
Copyright: Medical News Today 
Not to be reproduced without permission of Medical News Today 

Please use one of the following formats to cite this article in your essay, paper or report:

Rupert Shepherd B.Sc. "Cancer Screening In Older Patients Very Common." Medical News Today. MediLexicon, Intl., 13 Dec. 2011. Web.
28 Dec. 2011.

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Friday, December 9, 2011

Colorectal Cancer Screening

Expert Insights (from Quest Diagnostics patient information page)

A Two-pronged Strategy for Combating Colorectal Cancer

Thursday, March 31st
By: John L. Marshall, MD
Category: Oncology

Colorectal cancer a disease that is preventable, treatable and beatable, and for which early detection is of paramount importance.

Last year, colorectal cancer (CRC) caused an estimated 51,370 deaths in the U.S1.

Most of those deaths could have been prevented.

“When colorectal cancer is detected early and treated, the 5-year relative survival rate is 90%,” notes Dr. John Marshall. “This drops to around 70% for patients diagnosed with regional disease and 12% for those diagnosed with end stage disease2.”

CRC is the third most common cancer in the U.S., but the second leading cause of cancer related deaths3. Dr. Marshall sees two keys to promoting survival from CRC: more widespread screening and more targeted therapy.

A glaring need for more widespread screening

“Colon cancer is one of those diseases where early detection clearly matters,” Dr. Marshall says. “Yet screening rates are terrible. Only 50% of Americans over 50 years of age receive any kind of screening for CRC. That compares with a screening rate for breast cancer of around 70%4. And it’s tragic because regular screening could prevent as many as 60% of CRC deaths.5”

Why are screening rates so low? "Partly because the tests for CRC are difficult for patients to undergo," says Dr. Marshall of colonoscopies and sigmoidoscopies. "Fecal tests help a little, but it's no fun to collect stool. People would rather have a needle stuck in their arm. Better screening techniques and early detection are critical. The field has been moving slowly, which is why recent developments, such as a DNA blood test, are important." This new blood test option, methylated Septin 9, is now available to aid CRC detection for the more than 52 million individuals over 50 years of age, who do not follow guidelines and remain untested.

Genetic profiling for more targeted therapy

In addition to advances in promoting more widespread screening, Dr. Marshall sees promise in targeted testing once CRC is diagnosed. “We give everybody the same treatment up front and just hope that it will help. But we don't know who will benefit.” he says, “We need to get smarter about who gets which drug. We should know which patients are at risk and who needs adjuvant chemotherapy. With stage 2 and 3 patients, for example, deciding who needs adjuvant therapy is critical.”

Dr. Marshall points to genetic profiling as a major step toward evaluating the risks and determining which treatments patients should receive. “Genetic testing is making its way into clinical practice and having an impact on therapy,” he says. “People are getting away from the microscope and looking at certain gene or protein expressions to understand which treatment to select.”

The promise of more effective treatment

Dr. Marshall is optimistic that advances in genetic profiling will lead to more effective therapies. “The only way we’re going to get more effective medicine is through this concept of molecular profiling and targeted drug development.”

"The hope is that this will lead to additional breakthroughs – not necessarily for everyone with colon cancer, but for subsets of patients with specific kinds of colon cancer. I expect we will start to see these efforts come to fruition over the next three to five years."

Testing for CRC via the ColoVantage test can be found online at (under Cancer markers/screening tests)


National Cancer Institute, U.S. National Institutes of Health

National Cancer Institute, U.S. National Institutes of Health

American Cancer Society, Cancer Facts & Figures 2010

American Cancer Society, Breast Cancer Facts & Figures 2010

National Health Interview Survey Public Use Data File 2000, 2003, 2005,and 2008.

Author contributing to Expert Insights:

John L. Marshall, MD

Professor of Medicine

Chief, Division of Hematology-Oncology

Director, Clinical Research

Lombardi Comprehensive Cancer Center

Georgetown University

Washington, DC

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