Cancer Screening in Older Patients-Too Much of a Good Thing?

Two studies and a commentary published this week suggest that too much of a good thing can actually be a bad thing when cancer screening is involved.

“Cancer screening in the 21st century is losing its luster,” Cary P. Gross, MD, of the Yale University School of Medicine, wrote in his commentary. “Increasing evidence suggests that many modalities of cancer screening may be far less beneficial than first thought.”¹

In the first study, authors examined rates of prostate, breast, cervical and colorectal cancer screening in patients 65 or older using data from the National Health Interview Survey from 2000 through 2010.²

The study enrolled 27,404 participants who were grouped by risk (low to very high) of 9-year mortality.

The study found that in patients with very high mortality risk, 31% to 55% received recent cancer screening, with prostate cancer screening being the most common (55%).

“These results raise concerns about overscreening in these individuals, which not only increases healthcare expenditure but can lead to patient net harm,” the authors stated. “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 substantially reduce healthcare costs.”

The second study, which analyzed colonoscopy screening of Medicare patients, found that screening Medicare beneficiaries with colonoscopies more regularly than recommended only resulted in small increases in prevented CRC deaths and life-years gained but large increases in colonoscopies performed and colonoscopy-related complications in a simulated modeling study.³

“Screening Medicare beneficiaries more intensively than recommended is not only inefficient from a societal perspective; often it is also unfavorable for those being screened,” the authors stated in their discussion. “This study provides strong evidence and a clear rationale for clinicians and policymakers to actively discourage this practice.”

Gross’ commentary urges physicians to question the screening strategies for older patients.

“Patients with a shorter life expectancy have less time to develop clinically significant cancers after a screening test and are more likely to die from noncancer health problems after a cancer diagnosis,” he argues. “In addition, older persons face a higher risk of complications from procedures such as screening colonoscopy.”

References

• Gross CP. Cancer screening in older persons: a new age of wonder [published online ahead of print August 18, 2014] JAMA Intern Med.
• Royce TJ, Hendrix LH, Stokes WA, et al. Cancer screening rates in individuals with different life expectancies wonder [published online ahead of print August 18, 2014] JAMA Intern Med.
• van Hees F, Zauber AG, Klabunde CN, et al. The appropriateness of more intensive colonoscopy screening than recommended in Medicare beneficiaries: a modeling study [published online ahead of print August 18, 2014] JAMA Intern Med.