Cancer Screening May Not Benefit Elderly

Patients with limited life expectancy received cancer screenings that may not be helpful

(RxWiki News) Regular cancer screenings are widely regarded as an important part of preventive medicine, particularly for people in midlife. But those same screenings might cause more harm than good in older patients facing a limited life expectancy.

New research found that elderly patients were often screened for cancer, which could result in unnecessary medical tests and costs.

"Discuss cancer screenings with your primary physician."

The study was written by Trevor Royce, MD, of the Department of Radiation Oncology at the University of North Carolina at Chapel Hill, and colleagues.

The authors set out to examine the value of routine cancer screenings in patients with a limited life expectancy. They focused their study on rates of prostate, breast, cervical and colorectal cancers.

Using data collected between 2000 and 2010 on patients 65 or older, the researchers found 27,404 participants.

The patients were grouped by risk of dying within nine years. Low risk was considered 25 percent or less, and 75 percent or more was very high risk.

In the low-risk group, doctors screened 70 percent for prostate cancer, 74 percent for breast cancer, 70 percent for cervical cancer and 51 percent for colorectal cancer.

In the very high-risk group, doctors screened 55 percent for prostate cancer, 38 percent for breast cancer, 31 percent for cervical cancer and 41 percent for colorectal cancer.

Older age was associated with less screening across all cancers. Patients who were married, had more education, had insurance or had regular care providers were also more likely to receive screening.

The authors concluded that a “substantial proportion” of Americans with limited life expectancy were getting screening “that is unlikely to provide net benefits.”

“These results raise concerns about overscreening in these individuals, which not only increases health care expenditure but can lead to patient net harm,” according to a JAMA press release.

The authors called for creating “simple and reliable ways” to estimate life expectancy to reduce unnecessary screenings. That would put less strain on the patient both physically and financially (via health care costs), the researchers concluded.

In a related editorial, Cary Gross, MD, of the Yale University School of Medicine, wrote that many types of cancer screening “may be far less beneficial than first thought.”

“It is particularly important to question screening strategies for older persons," Dr. Gross wrote. "Patients with a shorter life expectancy have less time to develop clinically significant cancers after a screening test and are more likely to die from noncancer health problems after a cancer diagnosis.”

Dr. Gross also noted that older patients have a higher risk of complications from screenings.

The study was published online Aug. 18 in the peer-reviewed JAMA Internal Medicine.

The Doris Duke Charitable Foundation provided funding.

Editorial writer Dr. Gross disclosed receiving funding from private companies. The study authors did not disclose any conflicts of interest.

Review Date: 
August 18, 2014