- Researchers say adults over the age of 65 may be getting unnecessary cancer screenings.
- They say the screenings may not be beneficial due to the risk of side effects as well as the expected longevity of a patient.
- Experts say the screenings may be occurring because older adults want them and it’s a difficult conversation for a doctor to tell a patient they’re past the age where screenings are effective.
Older adults may be undergoing cancer screenings beyond the age recommended by the U.S. Preventive Services Task Force.
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“We hypothesized that people who are older or who have lower life expectancies would be less likely to report having received their cancer screenings recently, but we didn’t see strong evidence of this,” Jennifer Moss, PhD, an assistant professor of family and community medicine and public health sciences at Penn State and author of the study, said in a press release. “This pattern shows us that too many people are getting screened after a point when the screening is probably not going to provide benefit and may cause harm.”
“There are two reasons why people should stop screening for cancer,” Moss added. “First, when they ‘age out’ of the recommended screening age, or second, when their life expectancy is too low. As with any clinical procedure, there are risks from the cancer screening tests. These risks are even higher for people who have aged-out or who have a low life expectancy.”
Moss and colleagues used data from the Centers for Disease Control and Prevention’s (CDC) Behavioral Risk Factor Surveillance System, which collects information about health behaviors, such as screening for cancer.
The researchers analyzed data from more than 20,000 men and 34,000 women screened for colorectal cancer, as well as more than 82,000 women for cervical cancer and more than 38,000 women for breast cancer.
They found that 59 percent of men and 56 percent of women were over-screened for colorectal cancer. In addition, 45 percent of women were over-screened for cervical cancer and 73 percent of women were over-screened for breast cancer.
Dr. Carolyn Kaloostian, a family medicine physician and geriatric care specialist at Keck Medicine of USC in Los Angeles, says over-screening is likely due to a number of factors.
“Having the discussion that a patient no longer needs screening is a challenging topic to broach,” Kaloostian told Healthline. “There is also a lack of knowledge, time, and skills to develop an individualized discontinuation plan. Also, there is a lack of quality and process improvement initiatives in clinic and imaging centers in this regard.”
Robert A. Smith, PhD, is the senior vice president of cancer screening at the American Cancer Society. He says time pressures in medical appointments can make it difficult to have a conversation about cancer screenings.
“You can imagine that in the short duration of the average visit, it is hard to initiate a discussion with the patient that says it is time to focus on other priorities and cancer screening isn’t one of them,” he told Healthline. “Many doctors don’t have this skill no matter how much time they have. So, it is easier to just make the referral if the patient says, ‘And I need my mammogram.'”
Smith argues that for some older adults, there could be a benefit to cancer screening under certain circumstances.
“Most cancer risk is increasing with age. So, there still is potential to benefit from screening. Older adults should have an opportunity to avert a premature death from cancer as long as they are in good health,” he said.
Diana L. Miglioretti, PhD, a professor of biostatistics at the University of California, Davis, says one of the risks of unnecessary screening is over-diagnosis.
“Over-diagnosis occurs when an asymptomatic cancer is detected by screening that would have never otherwise been diagnosed or harmed the individual during their lifetime because the cancer is very slow growing or the person dies from other causes before it would cause symptoms,” Miglioretti told Healthline.
“Over-diagnosed cancers are typically treated the same as all other cancers because we can’t tell which are over-diagnosed,” she added. “Individuals often undergo aggressive treatments to treat these over-diagnosed cancers, such as surgery and chemotherapy, which could decrease their quality of life, but they experience no benefit from these treatments — they die at the same age regardless of whether treated. This is a very important harm of screening that becomes more frequent with age, given older individuals are much more likely to die from other diseases than younger individuals.”
Preventing unnecessary cancer screenings, the study researchers say, can be challenging.
Part of the problem is screening awareness campaigns and incentives for doctors to continue screening.
“The messaging of screening has never included any discussion about when to stop, so the public is not necessarily in tune to that and that’s part of the challenge,” Dr. Deanna Attai, an assistant clinical professor of medicine at the University of California, Los Angeles, told Healthline. “The worry of cancer outweighs sometimes the perception of risk or the understanding of risk. There are some situations where providers or health systems are incentivized for screening tests; sometimes it’s part of their performance metric.”
She says life expectancy estimates can also be problematic and are not always accurate.
“Any estimate of life expectancy is an estimate at best; we don’t have a crystal ball. I think these are some of the challenges and some of the reasons that screening continues even in older patients,” Attai said.
In the United States, primary care providers typically follow the guidelines set out by the U.S. Preventive Services Task Force. But there are guidelines from other organizations that vary in their recommendations of age cut-offs for screening.
Kaloostian notes that the American Academy of Family Physicians and the American Cancer Society recommend people ages 75 to 85 have a discussion with their doctor and decide whether to screen “based on the patient’s individualized health and screening history.”
She argues age, life expectancy, and overall goals of care should all be factored into the decision as to whether older adults should be screened for cancer.
“Unfortunately, patients may get into the habit of routine screening, expect this automatic referral, and it takes time and disruption of this momentum by a beloved provider to initiate a deeper conversation to guide a well-thought-out plan. This shared decision-making takes time and effort but produces meaningful patient-centered outcomes,” Kaloostian said.
Smith argues it’s not always appropriate to apply a standard cut-off age for stopping cancer screenings. He says it depends on the individual.
“Screening in older adults is both under- and over-utilized,” Smith said. “The challenge is to identify which older adults should not continue screening, and which can still benefit from screening. It is not a problem solved by setting an arbitrary date to stop screening. If the evidence is clear that continued screening has little benefit based on a history of screening results, then screening should cease.”