23 Jan Nearly 1/3 of Elderly Receive Non-Recommended Cancer Screening Tests
MedicalResearch.com Interview with:
Firas Abdollah, M.D., F.E.B.U.
(Fellow of European Board of Urology) Urology Fellow with the Center for Outcomes Research, Analytics and Evaluation
Vattikuti Urology Institute at Henry Ford Hospital in Detroit
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Abdollah: Cancer screening aims to detect tumors early, before they become symptomatic. Evidence suggests that detection and treatment of early-stage tumors may reduce cancer mortality among screened individuals. Despite this potential benefit, screening programs may also cause harm. Notably, screening may identify low-risk indolent tumors that would never become clinically evident in the absence of screening (overdiagnosis), subjecting patients to the harms of unnecessary treatment. Such considerations are central to screening for prostate and breast cancers, the most prevalent solid tumors in men and women, respectively. These tumors are often slow growing, and guidelines recommend against screening (non-recommended screening) for these tumors in individuals with limited life expectancy, i.e. those with a life expectancy less than 10 years. Unfortunately, our study found that this practice is not uncommon in the US. Using a nationwide representative survey conducted in 2012, we found that among 149,514 individuals 65 years or older, 76,419 (51.1%) received any prostate/breast screening. Among these, 23,532 (30.8%) individuals had a life expectancy of less than 10 years. These numbers imply that among the screened population over 65 years old, almost one in three individuals received a non-recommended screening. This corresponds to an overall rate of non-recommended screening of 15.7% (23,532 of 149,514 individuals).
Another important finding of our study was that there were important variations in the rate of non-recommended screening from state to state; i.e. the chance of an individual older than 65 to receive a non-recommended screening varies based on his/her geographical location in United States.
Finally, on a state-by-state level, there was a correlation (40%) between non-recommended screening for prostate and breast cancer, i.e. states that are more likely to offer non-recommended screening for prostate cancer are also more likely to offer non-recommended screening for breast cancer, and vice versa.
MedicalResearch: What should clinicians and patients take away from your report?
Dr. Abdollah: Physicians, as well as their patients, should consider life expectancy when deciding the necessity of prostate cancer or breast cancer screening. Screening individuals with limited life expectancy might cause more harm than good.
MedicalResearch: What recommendations do you have for future research as a result of this study?
Dr. Abdollah: Studies should focus on developing accurate and user-friendly life expectancy calculator. Moreover, efforts should focus on implementing these calculators in clinical practice, and measuring their efficacy in counseling patients.
MedicalResearch: Is there anything else you would like to add?
Dr. Abdollah: Measuring life expectancy might not be easy in clinical practice. First, there is no widely accepted, highly accurate life expectancy calculators.
Second, many life expectancy calculators are cumbersome, and require a lot of information that are not routinely available to the physician during the clinic visit.
Third, explaining the concept of life expectancy to patients and explaining why they don’t need a screening test might prove to be challenging. Finally, many patients might still want to undergo a screening test, even after discussing all the limitation of such a test.
Firas Abdollah, M.D., F.E.B.U. (2016). Nearly 1/3 of Elderly Receive Non-Recommended Cancer Screening Tests