by ecancer reporter Janet Fricker

Over half of US physicians continue to recommend screening for breast, cervical, colorectal and prostate cancer in patients aged over 75 years, reports a study in Archives of Internal Medicine. The findings come despite the US Preventive Services Task Force (USPSTF) screening guidelines stating there to be insufficient evidence for evaluation of mortality benefits in men and women older than 75 years.

In the study Keith Bellizzi and colleagues, from the University of Connecticut in Storrs, assessed rates of screening in older, racially diverse adults. The data was analyzed from the National Health Interview Survey (NHIS), an annual, in-person, nationwide survey of approximately 30 000 households used to track trends in illness and health status of non institutionalized US civilians.

Results showed that among adults aged 75 to 79 years 57% were screened for colorectal cancer, 62% for breast cancer, 53% for cervical cancer and 56% for prostate cancer. Among those aged 80 years or older 46% were screened for colorectal cancer, 50 % for breast cancer, 38 % for cervical cancer, and 42 % for prostate cancer.

In unadjusted analyses, screening prevalence rates varied according to race/ethnicity, but on multivariate regression analysis, these differences could be accounted for by low education attainments. The largest predictor of screening was a physician's recommendation for a specific test, with more than 50% of men and women older than 75 years reporting that their doctors promoted screening.

"A high percentage of older adults continue to be screened in the face of ambiguity of recommendations for this group," write the authors. Frameworks taking into account estimated life expectancy, risk of cancer death from indolent or aggressive disease, and patients’ values and preferences , suggest the authors,  might prove useful guidance in individualised cancer screening decisions for older adults.

In an accompanying editorial Louise Walter, from the University of California, San Francisco, writes that for older adults the likelihood of a person living long enough to benefit from cancer prevention and detection was small, while the likelihood of harm became greater. But she queried whether Bellizzi and colleagues had actually identified any problems in the quality of care being provided to older patients.

Reference

K  M Bellizzi, E S Breslau, a Burness. Less is more. Prevalence of Cancer Screening in Older, Racially Diverse Adults. Arch Intern Med 2011, 171: 2031-2037 doi:10.1001/archinternmed.2011.570