The value of regular testing of increasingly elderly men and women for risk of cancer is controversial. However, a new paper in the Archives of Internal Medicine has certainly added to our knowledge of just how widespread such testing may be … at least in the USA.
Bellizzi et al. set out to estimate the prevalence of cancer screening in a racially diverse cohort of adults of ≥ 75 years of age. To do this, they looked at data from the National Health Interview Survey, which is a national survey based on annual, in-person interviews, and is used to track health-related trends and behaviors across the U.S. civilian population. Specifically, individual “screening” behavior was analyzed for breast, cervical, colorectal, and prostate cancer risk, and was correlated against the recommendations of the U.S. Preventive Services Task Force.
Here are the study findings:
- The full analytic sample cohort included 49,575 individuals.
- 1,697 individuals were between 75 and 79 years of age.
- 2,376 individuals were ≥ 80 years of age.
- Among those aged 75 to 79 years, the percentages tested for cancer were as follows:
- 57 percent were tested for colorectal cancer.
- 62 percent were tested for breast cancer.
- 53 percent were teated for cervical cancer.
- 56 percent were tested for prostate cancer.
- Among those aged ≥ 80 years or older, rates of screening ranged from a low of 38 percent for cervical cancer to a high of 50 percent for breast cancer.
- Unadjusted screening prevalence rates differed by race and ethnicity; however, these differences could be accounted for by low education attainment.
- Physician recommendation for a specific test was the largest predictor of screening.
- > 50 percent of men and women older than 75 years report that their physicians continue to recommend screening.
The authors concluded that, “A high percentage of older adults continue to be screened in the face of ambiguity of recommendations for this group.”
This paper has received wide publicity. Several commentators have made points with which The “New” Prostate Cancer InfoLink is in complete agreement. These include the following:
- That screening of the elderly for risk of cancer needs to take careful account of
- The reasonable life expectancy of the individual (based on his or her physiological age)
- Any co-morbid conditions of the individual that may impact life expectancy
- The fundamental possibility of treatment if screening results are positive
- The risks and benefits of treatment if screening results are positive
- That a conversation about the value of continuing testing should be held between physician and patient so that the patient is making an informed decision about whether to continue such testing
We can not go on simply testing everyone in the way that we have in the past, regardless of other realities. In the case of prostate cancer, we are well aware that 80 percent of men of 80+ years of age will have pathologically identifiable cancer cells in their prostates. We are also well aware that the vast majority of 80-year-olds are not going to die of prostate cancer if they are diagnosed at that age with low-risk, localized disease. Are there some 80-year-olds who have a 15-year life expectancy, are in excellent health, and who — if diagnosed with Gleason 7 to 10 prostate cancer in their early 80s – could really benefit from immediate treatment? Yes there are. But we must be able to find a better way to identify these men than through the continuing use of PSA-based screening.