Cancer Screening Often Excessive in Older Patients

Patients with limited life expectancies often undergo routine cancer screenings despite evidence that they are unlikely to benefit and may experience harm.

Patients with limited life expectancies often undergo routine cancer screenings despite evidence that they are unlikely to benefit and may experience harm due to subsequent diagnostic procedures and overtreatment, according to a recent large population-based study.

Analyzing data on over 27,000 participants (age 65 or older) in the National Health Interview Survey between 2000-2010, researchers used a validated mortality index to categorize patients as having a low, intermediate, high, or very high risk of dying within 10 years. Among participants in the highest risk group, 31% to 55% recently underwent screenings for prostate, breast, cervical, and colorectal cancers, in conflict with major evidence-based guidelines. The results were published online in JAMA Internal Medicine.

Rates of overscreening were especially high for prostate cancer, researchers noted, possibly because physicians view the prostate-specific antigen (PSA) blood test as simple and safe but tend to overlook its potential harm.

“The costs of overdetection and overtreatment in prostate cancer have been reported,” the authors wrote. “While the screening test itself (PSA) is not costly, using this test in men who have a limited life expectancy leads to downstream consequences of cancer (over)diagnoses and (over)treatments that are costly and unlikely to provide net benefit to the patient.”

The use of life expectancy is important, the authors noted, as recent research suggests that age alone is insufficient to determine appropriateness of screening. For example, both the American College of Physicians and the American Society of Clinical Oncology recommend taking a patient’s general health and life expectancy into consideration when deciding whether to recommend screening for prostate cancer.

Physicians face obstacles to applying screening guidelines in practice, the authors acknowledged, such as the lack of an easy-to-use tool to accurately measure life expectancy. In addition, even when life expectancy is accurately assessed, it is often difficult for physicians to communicate-and for patients to accept-the prognosis. Research is needed to help overcome these barriers and find effective ways to reduce overscreening, they said.

Excessive cancer screening is also a significant contributor to skyrocketing health care costs, the authors noted. These findings suggest that creating simple and reliable ways to assess life expectancy may help reign in spending.

“Our study finds overscreening in some of the most common cancers and identifies a significant opportunity,” the authors wrote. “By reducing or eliminating the currently frequent use of cancer screening in individuals with limited life expectancy, we can decrease waste in health care spending and simultaneously improve patient outcomes on a population level by minimizing the unnecessary harms from cancer screening.”