Large numbers of elderly patients with low life expectancy still receiving unnecessary cancer screens

A substantial proportion of patients with limited life expectancy are receiving prostate, breast, cervical, and colorectal cancer screenings that are unlikely to benefit them, a recent study found.

Rates of self-reported cancer screening were gathered from 27,404 participants age 65 and over in the National Health Interview Survey, conducted annually from 2000 through 2010. Participants were grouped by their risk for mortality within 9 years: low (<25%), intermediate (25-49%), high (50-74%) and very high (≥75%). Results were published by JAMA Internal Medicine on Aug. 18.

Participants with increased mortality risk were less likely to be screened, but still 31% to 55% of the participants with very high mortality risk had been recently screened for at least 1 of the studied cancers (prostate, breast, cervical, and colorectal). Prostate screening was the most common at 55% of men. Excessive cervical screening was also common; of women who had had a hysterectomy for benign reasons, 34% to 56% had a Pap test within the past 3 years.

Screening was common even among participants with less than 5 years of life expectancy. Rates of prostate and cervical cancer screening decreased over the study period, but not significantly more in the lower life-expectancy groups than the higher ones. The results show that a substantial proportion of the U.S. population with limited life expectancy receive cancer screens that are unlikely to benefit them, the study authors concluded.

There is increasing recognition that life expectancy, rather than just age, is important to determining the appropriateness of screening, the authors said, citing ACP's recommendation that prostate cancer screening decisions be based in part on a patient's general health and life expectancy. However, life expectancy is difficult to calculate and to communicate to patients. Defensive medicine may also contribute to the overuse of screening, the authors speculated. They called for development of simple and reliable ways to assess life expectancy and education for physicians and patients to reduce these unnecessary screens, thereby decreasing wasteful spending and harms to patients.

An accompanying editorial noted that cancer screening has recently been “losing its luster” and suggested that, in addition to better life expectancy assessment, restrictions on Medicare payments for screening and quality measures that address overscreening could help to make cancer prevention/screening efforts more evidence based and patient centered.