Medical Care

Those with Not Long to Live Still Get Screenings for Cancer

A substantial number of older patients with limited life expectancy continue to receive routine screenings for prostate, breast, cervical, and colorectal cancer although the procedures are unlikely to benefit them, according to the authors of a study done at theUniversity of North Carolina at Chapel Hill by Trevor J. Royce, M.D., M.S. and colleagues.

An August 2014 release from Jama Network Journals notes that an aim of Healthy People 2020 is to increase the proportion of people who receive cancer screening consistent with the U.S. Preventive Services Task Force’s (USPSTF) evidence-based guidelines. And there is general agreement that routine cancer screening is unlikely to benefit patients with limited life expectancy.

The authors examined rates of prostate, breast, cervical and colorectal cancer screening in patients 65 or older using data from the National Health Interview Survey from 2000 through 2010. The study included 27,404 participants who were grouped by risk (low to very high) of nine-year mortality. Low mortality risk was defined as less than 25 percent and very high mortality risk was 75 percent or more.

Results: In patients with very high mortality risk, 31 percent to 55 percent received recent cancer screening, with prostate cancer screening being the most common (55 percent). For women who had a hysterectomy for benign reasons, 34 percent to 56 percent had a Papanicolaou test within the past three years. The overall screening rates for the study group were prostate cancer, 64 percent (ranging from 70 percent in individuals with low mortality risk to 55 percent in those with very high mortality risk); breast cancer, 63 percent (ranging from 74 percent among people with low mortality risk to 38 percent in patients with very high mortality risk); cervical cancer, 57 percent (ranging from 70 percent among low mortality risk patients to 31 percent in patients with very high mortality risk); and colorectal cancer, 47 percent (ranging from 51 percent for low-mortality risk patients to 41 percent for patient with very high mortality risk). There was less screening for prostate and cervical cancers in more recent years compared with 2000. Older age was associated with less screening for all cancers. Patients who were married, had more education, had insurance, or had a usual place for care were more likely to be screened.

“These results raise concerns about overscreening in these individuals, which not only increases health care expenditure but can lead to patient net harm. 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. There is considerable need for further dissemination efforts to educate physicians and patients regarding the existing screening guidelines and potential net harm from screening in individuals with limited life expectancy.”