Older Individuals Screened for Breast, Prostate Cancers Unnecessarily

More than 15% of men and women over the age of 65 may have received breast or prostate cancer screening not recommended by current guidelines, according to a study published in JAMA Oncology. This type of nonrecommended screening could potentially lead to unnecessary treatment costing the US healthcare system as much as $1.2 billion each year.

The National Comprehensive Cancer Network (NCCN) breast cancer and prostate cancer screening guidelines recommend against screening in older individuals with a life expectancy of less then 10 years, as the detection of cancer may lead to overdiagnosis and overtreatment and is not likely to increase survival for these individuals.

In the current study, Firas Abdollah, MD, of the Henry Ford Health System in Detroit, and coauthors evaluated the prevalence of non–guideline-based screenings for prostate and breast cancers among US individuals aged 65 years or older using data from the 2012 Behavioral Risk Factors Surveillance System survey.

“To our knowledge, our study is the first to report the extent and variation of nonrecommended screening across states,” wrote the study authors.

Of 149,514 individuals included in the analysis, 76,419 (51.1%) had been screened with either a prostate-specific antigen (PSA) test or mammography in the last year. Of these, 30.8% (23,532 individuals) had a life expectancy of less than a decade.

Nonrecommended screening rates varied state by state, ranging from the lowest rate in Colorado (11.6%) to the highest rate in Georgia (20.2%). States that had a high rate of nonrecommended screening for prostate cancer were also likely to have a high rate of nonrecommended screening for breast cancer and vice versa.

Limitations of the current study were potential overestimations of individuals’ life expectancies due to unmeasured comorbidities and the inclusion of men and women previously diagnosed with or treated for breast cancer or prostate cancer.

“Efforts should be deployed to reduce nonrecommended screening in states with a high rate of nonrecommended screening. This effort may avoid significant harms to many individuals and improve the cost efficiency of screening initiatives,” concluded the study authors.