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 Up to half of older people in the U.S. received cancer screenings
even though there was a high likelihood that they would die within
nine years without cancer, researchers report in JAMA Internal
Medicine.
“There is general agreement that routine cancer screening has little
likelihood to result in a net benefit for individuals with limited
life expectancy,” write Dr. Trevor Royce and his fellow researchers
from the University of North Carolina, Chapel Hill.
Several professional societies have updated their cancer screening
guidelines to suggest that people who aren’t expected to live
another 10 years should not be screened for certain cancers.
For example, the American Society of Clinical Oncology, the American
Cancer Society and the American Urological Association recommend
stopping prostate-specific antigen (PSA) screening among men not
expected to live another decade.
PSA screening involves a blood test that looks for a protein
produced by the prostate gland. High levels of the protein may
suggest the presence of prostate cancer.
"Each screening test carries different risks and benefits,” said
Keith Bellizzi of the University of Connecticut‘s Center for Public
Health and Health Policy in Storrs. "Individuals should be counseled
about these risks in order to make an informed decision (sometimes
involving caregivers or family members)."
Bellizzi was not involved with the new study but has done similar
research (see Reuters Health story of December 12, 2011 here:
http://reut.rs/1taT7L9).
“Having said that, the challenge for clinicians is to balance the
values and wishes of their patients with the available evidence
regarding the benefit or lack of benefit for a specific screening
test,” he wrote in an email to Reuters Health.
For the new study, the researchers analyzed data from a U.S. survey
collected between 2000 and 2010 that included responses from 27,404
people 65 years old and older.
They used the participants’ responses to estimate their risk of
death within the next nine years. Then, they looked to see who had
recently been screened for prostate, colon, breast and cervical
cancers.
In one way or another, medical organizations support stopping
screening for those four cancers among people with limited life
expectancy.
Despite those guidelines, the researchers found 55 percent of men
who had a 75 percent risk of death over the next nine years had
recently received a PSA screening.
About a third of women with the same life expectancy received breast
and cervical cancer screenings. Screening for cervical cancer was
also common among women who had already had a hysterectomy.
The researchers also found that 41 percent of people who were not
likely to live another decade were recently screened for colon
cancer.
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In an editorial accompanying the new study, Dr. Cary Gross of Yale
University in New Haven, Connecticut, writes that some research
found that older Americans receive colonoscopies within seven years
of their previous screening. Current recommendations suggest 10
years between colonoscopies with normal results.
Another study published in the same journal says that based on a
computer model, screening older adults with colonoscopies more than
once every 10 years produced small benefits.
Researchers led by Frank van Hees of Erasmus University Medical
Center in the Netherlands found that compared with screening older
Americans with colonoscopies every 10 years, screening them every
five years saved less than one additional life per 1,000 people.
Screening older Americans with colonoscopies every five years also
resulted in less than one quality year of life gained per 1,000
people at a cost of about $711,000.
“This new age of skepticism is providing us with critical tools to
better target screening efforts,” Gross wrote. “In situations in
which we are uncertain about whether benefits outweigh the risks, we
need to bolster our efforts to generate evidence that can inform
cancer screening decisions.”
While helpful, he added, additional research is inefficient and
doctors and regulators need to take steps to address the use of
cancer screenings among people with limited life expectancies.
"These findings support other studies that suggest certain segments
of the older population may be inappropriately screened for
cancers," said Bellizzi. "However, the health care response should
clearly not be a one size fits all solution."
He said older adults and their health statues differ from one
another.
"Age, in and of itself, should not be a proxy for health status or
be solely used as a decision tool regarding screening for a
particular cancer," he added.
SOURCE: http://bit.ly/1taSAbY,
http://bit.ly/1taSAce and http://bit.ly/1taSxNy JAMA Internal
Medicine, online August 18, 2014.
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