Older Patients with Limited Life Expectancy Still Receive Cancer Screenings

A substantial number of older patients with limited life expectancy receive routine screenings for prostate, breast, cervical and colorectal cancer even though the procedures are unlikely to benefit them, according to research conducted at the University of North Carolina at Chapel Hill.

In a paper published in JAMA Internal Medicine, a team led by Trevor J. Royce, MD, MS, of the UNC School of Medicine, and Ronald C. Chen, MD, MPH, of the UNC School of Medicine and the UNC Lineberger Comprehensive Cancer Center, examined rates of cancer screening in patients aged 65 years or older using data from the National Health Interview Survey from 2000 through 2010. The researchers found that 31 percent to 55 percent of patients who had a less than 9-year life expectancy received a recent cancer screening.

“These results raise concerns about overscreening in these individuals, which not only increases health care expenditure but can lead to patient net harm. Creating simple and reliable ways to assess life expectancy in the clinic may allow reduction of unnecessary cancer screening, which can benefit the patient and also substantially reduce health care costs,” according to Dr. Royce.

Dr Chen notes, "While cancer screening can be a controversial topic, there is general consensus in the medical community that cancer screening should stop for men and women with limited life expectancy because screening is unlikely to be of benefit to these individuals. An important message is that cancer screening can lead to harm to the patient, because screening tests can lead to subsequent invasive procedures like biopsy, and can also lead to 'overtreatment' of diagnosed cancers. For individuals who have a limited life expectancy, cancer screening tests likely lead to more harm than benefit."

The study found that the rate of screenings has decreased in recent years compared to 2000, and that older patients typically received less screenings. Patients who were insured, married, had more education or had a usual place for care were more likely to be screened.