Many older U.S. adults get cancer screenings beyond recommended ages

Last Updated: 2020-08-03

By Lisa Rappaport

(Reuters Health) - More than half of U.S. adults who are past the recommended age for colorectal cancer screenings get them anyway, and so do roughly three in four women too old for breast cancer screening and nearly half of women too old for cervical cancer screening, a new study suggests.

Researchers examined telephone data collected in 2018 from 176,348 community-dwelling adults with a median age of 75. They assessed overscreening based on recommendations from the U.S. Preventative Services Task Force (USPSTF), which sets an upper age limit of 75 for colorectal cancer screening, 74 for breast cancer screening, and 65 for cervical cancer screening.

Overall, 59.3% of men and 56.2% of women were overscreened for colorectal cancer, while 74.1% of women were overscreened for breast cancer and 45.8% of women were overscreened for cervical cancer, according to the report in JAMA Network Open.

Compared to people outside of metropolitan areas, overscreening was more common in urban areas for colorectal cancer in both men (adjusted odds ratio 1.17) and women (aOR 1.23), as well as for breast cancer (aOR 1.36) and cervical cancer (aOR 1.20) in women.

"These results translate to unnecessary costs and procedures," said lead study author Jennifer Moss, an assistant professor in family and community medicine at The Pennsylvania State University in Hershey.

"For older adults, we don't have good evidence that continuing to get screened improves their health outcomes, and in fact, these procedures carry some risks of harm that increase with age," Moss said by email.

Compared to white participants, overscreening was more common among black participants for all types of cancer and for Hispanic participants for all but colorectal cancer in women.

The odds of colorectal overscreening were higher in black and Hispanic men (aOR 1.32 and 1.91, respectively), compared with white men. Black and Hispanic women also had higher odds of overscreening for breast cancer (aOR 1.48 and 1.42, respectively) and cervical cancer (aOR 2.05 and 2.41, respectively). Black women were more likely than white women to be overscreened for colorectal cancer (aOR 1.27) but Hispanic women were not at increased risk (aOR 0.96).

One limitation of the study is that it relied on self-reported screening, and the researchers lacked data on certain clinical information such as a history of abnormal cervical cancer screenings that might have influenced screening decisions for individuals.

Still, the results underscore that physicians should carefully read screening guidelines, and be aware of their specific details so that they understand and follow them where applicable, said Dr. Richard Bleicher, a professor of surgical oncology and leader of the breast cancer program at Fox Chase Cancer Center in Philadelphia.

Clinicians also need to understand there can be disadvantages to screening that outweigh any benefits for older people, Dr. Bleicher, who wasn't involved in the study, said by email.

"While we often consider screening benign, at the extremes of recommended age, we should act deliberately, understanding the pros and cons, and have that discussion with our patients to make the best choice for their situation," Dr. Bleicher advised.

SOURCE: https://bit.ly/2BZuuiQ JAMA Network Open, online July 27, 2020.