A high percentage of adults age 75 years and older continue to report receiving cancer screenings, despite U.S. Preventive Services Task Force guidelines recommending against routine screening for breast, cervical, colorectal and prostate cancer for patients age 75 years and older, according to a report in the December 12/26 issue of Archives of Internal Medicine, one of the JAMA/Archives journals1. The article is part of the journal’s Less is More series.
“In the United States, the number of adults 65 years or older, currently estimated at 36.8 million, is expected to double by the year 2030. Providing high-quality care to this growing population while attempting to contain costs will pose a significant challenge,” the authors write as background information in the article. “While a great deal is known about cancer screening behaviors and trends in young and middle-aged adults, less is known about screening behaviors in older adults from different racial backgrounds.”
Keith M. Bellizzi, Ph.D., M.P.H., of the University of Connecticut, Storrs, and colleagues analyzed data from the National Health Interview Survey, an annual in-person nationwide survey used to track health trends in U.S. citizens, to estimate the prevalence of cancer screening among older, racially diverse adults. The study population included 49,575 individuals, 1,697 of whom were 75 to 79 years of age and 2,376 were 80 years of age and older.
Among women age 75 to 79 years and those 80 years and older, 62 percent and 50 percent, respectively, reported receiving a mammogram within the past two years. Similarly, 53 percent of women ages 75 to 79 years and 38 percent of women ages 80 years and older reported undergoing a Papanicolaou screen (also known as a pap smear or pap test) for cervical cancer within the past three years. Reported screenings for colorectal cancer in men and women were highest in the 75- to 79-year-old group, with 57 percent of participants reporting screening. Among men, prevalence of prostate cancer screening within the past year was highest in the 75- to 79-year-old group (57 percent) followed by the group that was 80 years and older (42 percent) and the 50- to 74-year-old group (40 percent).
Although analysis showed racial differences in breast, colorectal and prostate cancer screening among older adults, the authors found that these differences were accounted for by low education attainment, with individuals without a high school diploma significantly less likely to be screened for breast, cervical and prostate cancer, compared with adults older than 75 years with a college degree. Adults older than 75 years were also significantly more likely to be screened for breast, colorectal, and prostate cancer if they recalled that a physician recommended the test.
“A high percentage of older adults continue to be screened in the face of ambiguity of recommendations for this group,” the authors conclude. “Prevalence results from this study can serve as a benchmark for progress as we move the science of cancer screening in older, diverse adults forward.”
In an invited commentary2, Louise C. Walter, M.D., of the University of California, San Francisco and San Francisco Veterans Affairs Medical Center, writes that “there are no quality measures that address appropriate target rates for cancer screening in persons older than 75 years.”
“While at extremes in older age the likelihood of surviving long enough to benefit from potential detection and treatment of asymptomatic cancer becomes quite small and the likelihood of harm becomes quite large irrespective of other factors, Bellizzi et al were not able to calculate screening rates in subgroups older than 85 years owing to the small number participating in the survey,” writes Dr. Walter. “Still, the data by Bellizzi et al raise the issue of whether quality measures should address the overuse of cancer screening.”
“While it is useful to determine screening rates among persons in whom screening will likely result in net benefit or net harm, between these two groups is a large number of older persons in whom screening offers small or uncertain net benefit,” Dr. Walter writes. “For these persons, the decision about whether the potential benefits of screening outweigh the risks is a value judgment that requires informed decision-making.”
“While arguments persists about what is the ‘right’ rate of cancer screening in older persons, it seems clear that the rate of informed decision-making should approach 100 percent,” she concludes.
1. (Arch Intern Med. 2011;171:2031-2037.
2. (Arch Intern Med. 2011;171:2037-2038.