High percentage of elderly patients screened for cancer
■ Physicians are leaning toward screening patients older than 75 in the absence of clear guidelines about whether they should do so, according to a study.
By Tanya Albert Henry — Posted Jan. 2, 2012
While there are questions about the effectiveness of cancer screening for adults older than 75, they don't appear to be stopping physicians from ordering such tests for their elderly patients.
A study published in the Dec. 26, 2011, Archives of Internal Medicine found that a "high percentage" of older adults are receiving cancer screenings.
The study, part of the journal's "Less is More" series studying how less care can result in better health, found that among those 75 to 79 years old:
- 62% of women were screened for breast cancer in the past two years.
- 53% of women were screened for cervical cancer in the past three years.
- 56% of men were screened for prostate cancer in the past year.
- 57% of men and women were screened for colorectal cancer through a fecal occult blood test within the past year, a sigmoidoscopy in the past five years or a colonoscopy in the past 10 years.
For women 80 and older: 38% underwent cervical cancer screening in the past three years, 50% received a mammogram in the past two years. For men 80 and older, 42% underwent prostate cancer screening in the past year.
Researchers looked at data covering 4,073 adults 75 and older from the National Health Interview Survey, an annual survey that tracks health trends among U.S. citizens. They found that older adults with lower levels of education were less likely to be screened for breast, cervical and prostate cancer compared with those who have a college degree.
"With heterogeneity in the health status of this older population, it is likely that continued screening for certain population segments is warranted, but making that determination is complex," study authors concluded.
Part of what makes it complex is the "lack of clarity" in U.S. Preventive Services Task Force screening guidelines, study authors wrote. Current guidelines "suggest that there is insufficient evidence to evaluate the mortality benefits of screening men and women older than 75 years." The recommendation is that physicians make individualized decisions on screening for people in this age group.
However, the study noted that with the "paucity" of data from screening and treatment trials for the oldest adults, decisions to screen are often based on "physicians' extrapolations from screening trials in younger adults, clinicians' subjective judgment of a person's health status, and patient preference."
Regarding patient preference, other studies, the Archives report noted, found that 72% of those older than 70 would continue cancer screening throughout their lives, and 43% of those who would continue screening would do so even if physicians recommend against it.
In a commentary that accompanied the study, geriatrician Louise C. Walter, MD, said physicians treating adults older than 75 should stop and ask themselves whether a cancer screening is the best course of action for a particular patient.
One 80-year-old patient may be climbing mountains and benefit from catching an asymptomatic cancer. Another patient may have dementia and be bedridden, resulting in a screening procedure potentially causing more harm than good.
"We need to change the way we think about cancer screening and not think about it as a check- the-box item that is done or not done because someone is a certain age. We need to think about screening as an intervention," said Dr. Walter, a professor of medicine in the division of geriatrics at the University of California, San Francisco.
She agreed that physicians can't just look at the screening percentages for a population broken down by age and determine whether that cancer screening rate is right or wrong.
"While arguments persist 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%," she concluded in the commentary.
Study authors called for more research to examine factors that influence the decisions of physicians and patients about whether a screening takes place. The authors noted that further studies are particularly important because the number of adults 65 or older is expected to double by 2030, brining that population to more than 70 million.