More Than 50% of Older, Sick Adults Receive Cancer Screenings Unlikely to Provide Benefit
Despite updates on cancer screening guidelines from several medical societies—including ASCO, the American Cancer Society, the American Urological Association, the American College of Physicians, as well as the U.S. Preventive Services Task Force—which use life expectancy and/or age as a parameter for screening cessation, a new study finds that more than half of older people receive routine cancer screenings even though they are unlikely to provide a net benefit. The findings suggest that overscreening is common and can lead to both patient harm and increases in health-care expenditures. The study by Royce et al is published in JAMA Internal Medicine.
Study Methodology
Researchers from the University of North Carolina at Chapel Hill analyzed data regarding the rates of cancer screenings for prostate, breast, cervical, and colorectal cancer from the population-based National Health Interview Survey (NHIS) from 2000 through 2010 among 27,404 participants age 65 and older. Using a validated mortality index based on NHIS data, the researchers grouped participants into those with low (< 25%), intermediate (25%–49%), high (50%–74%, and very high (≥ 75%) risks of 9-year mortality. The 9-year life expectancy was chosen for the main analysis because a validated mortality index exists, and this duration is similar to the 10-year cutoff used by many cancer societies, including ASCO, in their guidelines for cancer screening cessation.
The NHIS collected participant-level sociodemographic variables, including race, age, marital status, education, region, insurance status, and usual place of medical care.
Results
The researchers found that 31% to 55% of participants with very high mortality risk received recent cancer screening, with prostate cancer screening being the most common (55%). For women who had a hysterectomy for benign reasons, 34% to 56% had a Pap test within the past 3 years.
Multivariate analysis revealed that very high vs low mortality risk was associated with less screening for prostate (odds ratio [OR] = 0.65, 95% confidence interval [CI] = 0.50–0.85), breast (OR = 0.43, 95% CI = 0.35–0.53), and cervical (OR = 0.50, 95% CI = 0.36–0.70) cancers. There was less screening for prostate and cervical cancers in more recent years compared with 2000, and there was no significant interaction between calendar year and mortality risk for any cancer screening (P > .05 for all cancers). Their sensitivity analysis showed that screening was also common in individuals with a life expectancy of less than 5 years.
“These results raise concerns about overscreening in these individuals, which not only increases health-care expenditure but can lead to patient net harm,” concluded the study authors. “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.”
Ronald C. Chen, MD, MPH, of the University of North Carolina at Chapel Hill, was a corresponding author of this study.
Funding for the study was provided by grant from the Doris Duke Charitable Foundation. The researchers reported no conflicts of interest.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
