Cancer Screening Rates Are Too High in Older Adults with Limited Life Expectancy

[Argirios Argiriou]

August 22, 2014
Cancer Screening Rates Are Too High in Older Adults with Limited Life Expectancy.
Thomas L. Schwenk, MD reviewing Royce TJ et al. JAMA Intern Med 2014 Aug 18.

Between 31% and 55% of patients at very high risk for dying within 9 years underwent recent cancer screenings.

Many health organizations recommend against routine cancer screening in patients with short life expectancies (generally, <10 years), but inappropriately high screening rates persist (NEJM JW Gen Med Mar 20 2014). Investigators assessed self-reported cancer screening in about 27,000 older adults (age, ≥65) who were queried periodically between 2000 and 2010. A validated instrument was used to calculate 9-year mortality risk for each participant, and participants were grouped from low (<25%) to very high (≥75%) risk.

Overall screening rates for prostate, breast, cervical, and colorectal cancer declined with increasing 9-year mortality risk, but recent screening occurred at relatively high rates (55%, 38%, 31%, and 41%, respectively) among patients with the highest 9-year mortality risk. Likewise, screening rates declined with age, yet 55% of older women (age, ≥75) underwent screening for breast cancer, and 31% of the oldest adults (age, ≥85) were screened for colorectal cancer. Among women with prior hysterectomies for benign indications (a group for whom Papanicolaou smear is not recommended), 34% of those at high 9-year mortality risk had Pap smears within the past 3 years. Patients who had more education, were married, had health insurance, or had sources of medical care were more likely to be screened.

Comment

Although no “right” rate of screening can be specified for all the categories of adults who were assessed, some screening rates are disturbingly high, especially in patients for whom screening absolutely is not recommended. One major barrier to discontinuing screening based on life expectancy or older age is the difficult conversation that starts when a clinician recommends no screening, and the patient responds, “What? Do you think I'm too old to be screened?”

Citation(s):

    Royce TJ et al. Cancer screening rates in individuals with different life expectancies. JAMA Intern Med 2014 Aug 18; [e-pub ahead of print]. (Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος)

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[Denominator]

Αν αφήσουμε έναν ηλικιωμένο με αδιάγνωστο Ca προστάτου (ας αφήσουμε τα υπόλοιπα νεοπλάσματα που έχουν δυσχερέστερη αντιμετώπιση), δυνητικώς θεραπεύσιμο, δεν έχει πολύ περισσότερες πιθανότητες να πεθάνει τα προσεχή 9 έτη;

[Argirios Argiriou]

Mortality Results from a Randomized Prostate-Cancer Screening Trial.

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The Great Prostate Mistake.

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over a period of 7 to 10 years, screening did not reduce the death rate in men 55 and over.
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[Denominator]

Πιστεύω ότι η διαδικασία πρέπει να είναι πιο εξατομικευμένη. Συμφωνώ στο ότι γενικευμένες προσεγγίσεις δεν οδηγούν πουθενά.