The Millstone Times December 2021

Many Older Adults Screened Unnecessarily for Common Cancers Monroe Township News | As We Age

Many older adults are being screened for cancer who no longer need to be, results from a new study show. Based on a nationwide survey, the study found that at least half of older adults had received at least one unnecessary cancer screening test in the previous few years. The United States Preventive Services Task Force (USPSTF) recommends that people at average risk of cancer get colorectal cancer screening through age 75, breast cancer screening through age 74, and cervical cancer screening through age 65. In general, above those ages, people have a greater likelihood of being harmed by than benefiting from these tests, explained Barry Kramer, M.D., M.P.H., of NCI’s Division of Cancer Control and Population Sciences, who was not involved in the study. The term "overscreening" is used to describe the use of such tests past the point where they are likely to provide a net benefit. People often aren’t aware that there are potential harms from cancer screening, explained Jennifer Moss, Ph.D., from Penn State University, who led the new study, which was funded in part by NCI and published July 27 in JAMA Network Open. These harms can include false-positive test results that lead to unnecessary follow-up procedures. “But what we’re particularly worried about for older adults is the harm from the test itself. All of these screening tests are medical procedures that have potential side effects,” Dr. Moss said. This risk of harm is highest for invasive tests, such as colonoscopy. Studies have shown that the overall benefits of screening, such as detecting cancer earlier when it's potentially easier to treat, outweigh the likelihood of harms in younger adults. However, the harms increase as people age. Screening tests usually pick up slower growing cancers. “For some tests, it can take 10 to 15 years, or even more, to reveal their benefits. The older you are, the less likely you are to reap those benefits,” said Dr. Kramer. As people grow older, the more they are likely to die of another cause before a cancer that might have been detected early on a screening test would have caused symptoms. “The harms, however, are front-loaded: they often occur at the time of the test or shortly thereafter,” he said. “That's why these recommendations are in place, to make sure that people who get screened are going to benefit and that the likelihood of the risks or harms are minimized to the extent possible,” Dr. Moss added. Even during the current pandemic, if you find a lump or experience bleeding or other concerning symptoms, “get to your doctor,” he said. “That’s not screening—that’s workup of a potentially serious problem.” But overall, the study results highlight that better education about cancer screening in older adults is needed, for both clinicians and the public, said both Dr. Moss and Dr. Kramer. “When we hear public service announcements or people talking generally about cancer screening, we don't hear a lot about the age when you should stop getting screened,” Dr. Moss said. Among both clinicians and the public, she continued, “I think that there's pretty low awareness of when older adults should graduate out of screening.” “Many practitioners are not aware of what the guidelines are,” agreed Dr. Kramer. But also, he added, conversations about stopping screening are difficult ones, particularly if a clinician has a long-term relationship with someone. “A physician who for years has been ordering tests for their patients may find it very difficult to say, 'You've reached the point where you're not likely to live long enough [to benefit],’” he said. A Need for Informed Decision-Making It’s also likely that a subset of older adults with good health and longer life expectancy would benefit from continued screening, but it’s not yet clear exactly who those people are, said Dr. Moss. More research is needed in this area, she added. “When estimating the balance between benefits and harms, there’s often an upper age range. But that age range, the upper limit, is not fixed in stone as years go by,” said Dr. Kramer. More research is also needed into when and how to have conversations about stopping screening, added Dr. Moss. “There's a lot that we can learn from practice around lung cancer screening and prostate cancer screening,” she said. “Both of those screening tests are not really recommended for everyone who walks through the door. You're supposed to talk to your provider about whether or not it's appropriate for you, what your risks are, and what would the risks be of the test itself. “We’ve done some focus groups with older adults about how people would want to talk about stopping screening with their provider,” she explained. “And a lot of older adults are really willing to [have these conversations]. They want information that’s very targeted to them and their personal health risks.”

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