Elders Might Be Overscreened for Cancer
The prostate cancer screening rate seems particularly excessive.
Exclusion of older adults from many screening studies and the variable benefits derived from screening when underlying chronic diseases are present have led to uncertainty about what cancer screening rates are “right” for elders. Researchers used data from a U.S. nationwide in-person interview survey to assess cancer screening rates in nearly 50,000 adults (including 1697 who were aged 75 79 and 2376 who were ¥80).
For breast cancer screening, 50% of women 80 and older underwent mammography versus 62% of those who were 75 to 79 and 74% of those who were 50 to 74. For colorectal cancer screening, rates were 47% for participants who were 80 and older, 57% for those who were 75 to 79, and 48% for those who were 50 to 74. Prostate-specific antigen testing was performed during the previous year in 42% of men who were 80 and older, in 57% of men who were 75 to 79, and in 40% of men who were 50 to 74.
Among participants who were 75 to 79, blacks were less likely to be screened for any of these three cancers than were whites, but this disparity was offset by differences in educational attainment. Patients without high school diplomas were roughly 50% to 60% less likely to be screened than were those with college degrees. More than half of participants who were 75 and older recalled receiving physician recommendations for one or more cancer screenings.
Comment: These cancer screening rates seem inappropriately high, particularly for prostate cancer screening. However, these rates also reflect the known preference by many patients for continued cancer screening, regardless of age or lack of physician recommendation.
Thomas L. Schwenk, MD
Published in Journal Watch General Medicine January 5, 2012
Bellizzi KM et al. Prevalence of cancer screening in older, racially diverse adults: Still screening after all these years. Arch Intern Med 2011 Dec 12/26; 171:2031. [Medline ® Abstract]
Copyright © 2012. Massachusetts Medical Society. All rights reserved.
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