AIM: Cancer screening common among older adults, but is that a problem?

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doctor-patient consult, elderly - 140.78 Kb

A high percentage of older adults continue to report receiving cancer screenings, despite ambiguity of recommendations and the U.S. Preventative Services Task Force guidelines recommending against routine screening for breast, cervical, colorectal and prostate cancer for patients age 75 and older, according to a report published in the Dec. 12/26 issue of Archives of Internal Medicine. An accompanying commentary acknowledged the high rates of cancer screenings, but argued that an ideal cancer screening model is hard to define.

Keith M. Bellizzi, PhD, MPH, of the University of Connecticut in Storrs, and colleagues wanted to examine screening behaviors in older adults from different backgrounds, since less is known about screening trends in older adults than is known about young and middle-aged adults.

“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,” wrote the authors. “Providing high-quality care to this growing population while attempting to contain costs will pose a significant challenge.”

The researchers 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 of whom were 80 years of age and older.

Results showed that among women aged 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 aged 80 years and older reported undergoing a Papanicolaou screen 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 at 57 percent, followed by the 80 years and older group at 42 percent and the 50- to 74-year-old group at 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, where individuals without a high school diploma were 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 also were 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 concluded. “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.”

But what is the “right” cancer screening rate for older age groups? That is the question asked by Louise C. Walter, MD, of the University of California, San Francisco, in an accompanying commentary. Quality measures in cancer screening focus on age and do not distinguish between a potentially harmful screening in a frail 80-year-old with a serious medical illness and a potentially beneficial screening in a healthy 80-year-old with no previous screening.

“Given the tremendous heterogeneity of the elderly population, we need to move beyond using age alone to define who is being overscreened,” wrote Walter.

Walter recommended that quality measurements should focus on subgroups of older patients in which there is no controversy that clinicians should not recommend screening. Examples of cases where screening rates should be low include cervical cancer screening for women of any age who have had a total hysterectomy for benign disease and colorectal cancer screening for people of any age within 10 years of receiving normal colonoscopy results.