19 August 2014
Screening shouldn't be done when patients have less than a 10-year life expectancy, researchers say
MONDAY, Aug. 18, 2014 (HealthDay News) Older people who aren't expected to live more than 10 years are still being screened for prostate, breast, cervical and colon cancer even though it is unlikely to benefit them, a new study finds.
Unnecessary screening can lead to invasive procedures, such as biopsies, and unneeded treatments including surgery, radiation and chemotherapy, all of which can affect quality of life without extending it, the researchers said.
"Across the U.S., there seems to be a lot of cancer screening in patients who have a short life expectancy," said lead researcher Dr. Ronald Chen, an assistant professor of radiation oncology at the University of North Carolina at Chapel Hill.
"For patients who have a limited life expectancy, cancer screening might cause them more harm than benefit," Chen said. "Most guidelines recommend that we stop screening for these cancers when the patient has a short life expectancy. There is no evidence that cancer screening helps patients who have less than 10 years to live."
Chen thinks that in some cases patients expect screening, and it may be difficult for their doctor to tell them that screening isn't necessary.
Patients need to be educated about the benefits and harms of screening, Chen said. "We may have to educate physicians, too," he said.
The report was published online Aug. 18 in the journal JAMA Internal Medicine.
Dr. Cary Gross, a professor of medicine at the Yale University School of Medicine and author of an accompanying editorial in the journal, said, "We have reached a critical juncture in the history of cancer screening."
Cancer screening has really taken off over the past 40 years, he said. "While there has been enthusiasm about cancer screening, there is now increased recognition that screening may not be as effective as we had hoped and, for some patients, it may not be beneficial at all," Gross said.
Cancer screening is complex, and patients should take the time to ask their doctors about the risks and benefits, he said.
"People should ask about their probability of dying from cancer if they are screened, compared to if they are not screened. Also, they should ask about which type of test is best for them, and why the doctor recommends it," Gross said.
"We need to take the same approach to making decisions about cancer screening that we would for making other important health decisions," he said. "The medical community had pitched cancer screening as a no-brainer type of a decision. It's now clear that this is not the case. Screening has benefits, but also risks and costs caveat emptor [let the buyer beware."
For the study, Chen and colleagues used data from the U.S. National Health Interview Survey (from 2000 through 2010) to collect data about cancer screening on more than 27,000 men and women aged 65 and older, and ranked them according to the risk they had of dying within 10 years.
The investigators found that among people at the highest risk of dying within 10 years, 31 percent to 55 percent were screened for cancer. Prostate cancer screening was common among the men in this high-risk group (55 percent). Among women who had a hysterectomy for benign reasons, 34 percent to 56 percent had been given a Pap test within the past three years.
The screening rates for all the patients was 64 percent for prostate cancer, 63 percent for breast cancer, 57 percent for cervical cancer and 47 percent for colon cancer, the study authors noted.
Chen's team also found that fewer men were screened for prostate cancer and fewer women for cervical cancer in more recent years, compared with 2000.
In addition, the older a patient, the less likely he or she was to be screened. Married patients, better educated patients and those with health insurance and their own regular doctor were more likely to be screened, the researchers noted.
In another study in the same journal, Frank van Hees, a researcher in the department of public health at Erasmus University Medical Center in Rotterdam, the Netherlands, looked specifically at colon cancer screening.
"Many U.S. elderly are screened for colon cancer more frequently than recommended," he said.
These researchers noted that one in every five elderly adults who had a colonoscopy that found no cancer had another colonoscopy after five years, instead of the recommended 10 years.
Moreover, one in every four who had a negative screening colonoscopy at age 75 or older got another screening at an even more advanced age, van Hees said. Current recommendations say that routine screening is not needed after age 75, the researchers added.
"Our study shows that, in average-risk individuals, these practices are not only a waste of scarce health care resources, often they are associated with an unfavorable balance of benefits and harms," van Hees said.
Visit the U.S. National Cancer Institute for more on cancer screening.