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Cancer Overscreening High Among Older Adults

Mammogram machine.

Overscreening for colorectal, cervical, and breast cancer is prevalent among older adults in the United States, according to the results of a new study.

While routine cancer screening for adults with average cancer risk is recommended by the US Preventive Services Task Force (USPSTF), it is recommended that screening be discontinued once individuals reach a specified upper age limit, defined as age 75 for colorectal cancer, age 65 for cervical cancer, and age 74 for breast cancer. However, many average-risk older adults continue to undergo cancer screening after surpassing the upper age limit, leading to potential screening-related risks and increased health care costs.

In a study now published in JAMA Network Open, a team of researchers led by first author Jennifer L. Moss, PhD, Assistant Professor in the Departments of Public Health Sciences and Family and Community Medicine at Pennsylvania State University College of Medicine, investigated the prevalence and demographic characteristics of overscreening for colorectal, cervical, and breast cancers among older adults. The study included 176,348 individuals in the 2018 Behavioral Risk Factor Surveillance System, a dataset managed by the US Centers for Disease Control and Prevention.

Of the participants, 88.1% were women, 85.6% were non-Hispanic white, and 65.7% lived in metropolitan areas. Patients had a mean age of 75.0 years. Patients with a history of colorectal, cervical, or breast cancer were excluded. Screening methods included sigmoidoscopy, colonoscopy, or blood stool tests for colorectal cancer; Papanicolaou tests or human papillomavirus tests for cervical cancer; and mammography for breast cancer.

Overscreening was reported in at least 45% of participants in each of the cancer type subgroups. Colorectal cancer overscreening was reported in 59.3% of men and 56.2% of women. Cervical cancer overscreening was reported in 45.8% of women, and breast cancer overscreening was reported in 74.1% of women. Among women aged 76 or older, 17.1% were overscreened for all three cancer types. Metropolitan areas saw higher rates of overscreening for breast cancer (adjusted odds ratio 1.36), colorectal cancer (1.23), and cervical cancer (1.20) among women, compared with nonmetropolitan areas.

"To our knowledge, this is the first study demonstrating the high prevalence of older adults receiving cancer screenings that are not recommended by USPSTF or supported by randomized clinical trials," conclude Dr. Moss and colleagues. "This pattern emphasizes the need for additional research to identify risks and benefits of screening in older adults and to determine who may benefit from screening after the recommended upper age limits. In the meantime, interventions to reduce overscreening are needed to improve preventive care, reduce patient harms and health care costs, and increase the efficiency of health systems and public health programs."

For More Information

Moss JL, Roy S, Shen C, et al (2020). Geographic variation in overscreening for colorectal, cervical, and breast cancer among older adults. JAMA Netw Open, 3(7):e2011645. DOI:10.1001/jamanetworkopen.2020.11645

Image credit: Saeima. Licensed under CC BY-SA 2.0

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