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Older Adults Commonly Overscreened for Cancer — Physician’s First Watch

Medical News |
August 19, 2014

Older Adults Commonly Overscreened for Cancer

By Kelly Young

Edited by Jaye Elizabeth Hefner, MD

Two studies in JAMA Internal Medicine delve into the topic of overscreening older adults for cancer.

In the first, researchers calculated 9-year mortality risk for roughly 27,000 people aged 65 and older who completed the National Health Interview Survey. For participants with a 9-year risk of 75% or higher:

  • 55% of men had a PSA test within 2 years;

  • 38% of women had a mammogram within 2 years;

  • 31% of women had a Pap test within 3 years;

  • 41% of men and women had colorectal cancer screening within 5 years.

In the second study, researchers simulated "recommended screening" for colorectal cancer (colonoscopies at ages 65 and 75), shorter screening intervals, and screening beyond age 75 among average-risk 65-year-old Medicare beneficiaries. Recommended screening translated to a net benefit of 64.5 quality-adjusted life-years (QALYs) gained per 1000 beneficiaries. When screenings were done after age 75, QALYs declined. When the screening interval was shortened from 10 to 5 years, there was a gain of 0.7 QALYs per 1000 beneficiaries, but the cost per additional QALY gained was $711,000.

A commentator recommends that clinicians change the way they speak with older patients about cancer screening, noting that "assessment of life expectancy should inform individual decision making."

Reader Comments (4)

Bruce J. Stringer, M.D. Physician, Radiology

I just had my routine screening 10 year followup colonoscopy. Exam was totally negative as was my first one at age 55. My GI wanted me to repeat my first colonoscopy in 5 years because my father had a 3-4 cm pedunculated adenomatous polyp at age 61. I declined against his strong urging. Even after a completely normal exam 10 years later he still wants to repeat in 5 years. I am even less inclined to agree since I feel that I clearly do not share my father's tendency to grow polyps. If I as a Physician am subject to this sort of pressure to over screen with a procedure that carries non-trivial risks imagine what a lay person is up against!

danny lancaster Physician, Infectious Disease, retired

Stop paying for nonsense and the nonsense will cease (or at least decrease)

Ellen Lerner, BSN

I never (but should have) taken a course in statistics. I don't understand this article. what is a "simulated" screening? I don't know what you mean by quality-adjusted life years. Is this from medical point of view? The patient's health or how much the patient can function in most activities in life? Or just length of life left. Maybe some don't need cancer screening in their older years, but some do. Does everything these days come down to cost vs quality of life or length of days? Do the last years of a person's life need to be miserable, not to mention expensive, b/c of a cancer that may have been prevented by screening? Not sure what this study really means.

Tracy Kolenchuk Healthicine.org

When you only have a hammer - everything is treated like a nail.

Cancer screening has the potential to be much more effective if we integrate, and first, screen via health, and collect and understand the statistics resulting from the integration of health screening into cancer screening. Two simple questions: BMI (or a similar appropriate measure like height vs waist size), and exercise would be first. Then, a more complex question, often totally ignored by physicians - diet. What do you eat on a regular basis? We can add in questions about smoking, and other inflammatory habits - and easily remove many people from the need for frequent cancer screens, while encouraging others to more frequent cancer screening.

It is not an "assessment of life expectancy should inform individual decision making", it should be an assessment of healthiness.

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