Cancer Screening in Older Patients

 

Am Fam Physician. 2016 Apr 15;93(8):659-667.

  Patient information: See related handout on cancer screening, written by the authors of this article.

  Related letter: Physicians Making Eye Contact with Patients Is Important

Author disclosure: No relevant financial affiliations.

Although cancer is the second leading cause of death among persons 65 years and older, there is a paucity of clinical trial data about the effectiveness and harms of cancer screening in this population. Given the heterogeneous nature of the older population, cancer screening in these patients should not be based on age alone. Studies suggest that a life expectancy of at least 10 years is necessary to derive a survival benefit from screening for breast and colorectal cancers; therefore, screening for these cancers is not recommended in those with a life expectancy of less than 10 years. Prostate cancer screening, if performed at all, should not be performed after 69 years of age. Cervical cancer screening may be stopped after 65 years of age if the patient has an adequate history of negative screening results. An individualized approach to cancer screening decisions involves estimating life expectancy, determining the potential benefits and harms of screenings, and weighing those benefits and harms in relation to the patient's values and preferences.

Cancer is the second leading cause of death among those 65 years and older, and the incidence of cancer increases with age.1 Because of a lack of clinical trials that include older patients, there is a paucity of data about the effectiveness and harms of cancer screening in this population. Recommendations for cancer screening in older adults vary, particularly regarding when to stop screening. Such guidelines are based on evidence derived at population levels; are based on younger patients; and generally do not address individual variations in life expectancy, comorbid conditions, functional status, or personal preference.

Basing guidelines for cancer screening in older adults on age alone is problematic given the heterogeneous nature of this population. As Americans live longer, there is a need for more evidence-based guidance. This article reviews current guidelines and data, and offers suggestions on how physicians can incorporate these guidelines into their daily practice.

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BEST PRACTICES IN PREVENTIVE MEDICINE: RECOMMENDATIONS FROM THE CHOOSING WISELY CAMPAIGN

RecommendationSponsoring organization

Do not recommend cancer screening in adults with a life expectancy of less than 10 years.

Society of General Internal Medicine

Do not recommend screening for breast, colorectal, or prostate cancer if life expectancy is estimated to be less than 10 years.

Society for Post-Acute and Long-Term Care Medicine

Do not screen women older than 65 years for cervical cancer who have had adequate prior screening and are not otherwise at high risk of cervical cancer.

American Academy of Family Physicians

Do not perform screening for cervical cancer in low-risk women 65 years or older and in women who have had a total hysterectomy for benign disease.

American College of Preventive Medicine

Avoid colorectal cancer screening tests in asymptomatic patients with a life expectancy of less than 10 years and no family or personal history of colorectal neoplasia.

American College of Surgeons

Do not perform prostate-specific antigen testing for prostate cancer screening in men with no symptoms of the disease when they are expected to live less than 10 years.

American Society of Clinical Oncology


Source: For more information on the Choosing Wisely Campaign, see http://www.choosingwisely.org. For supporting citations and to search Choosing Wisely recommendations relevant to primary care, see http://www.aafp.org/afp/recommendations/search.htm.

BEST PRACTICES IN PREVENTIVE MEDICINE: RECOMMENDATIONS FROM THE CHOOSING WISELY CAMPAIGN

RecommendationSponsoring organization

Do not recommend cancer screening in adults with a life expectancy of less than 10 years.

Society of General Internal Medicine

Do not recommend screening for breast, colorectal, or prostate cancer if life expectancy is estimated to be less than 10 years.

Society for Post-Acute and Long-Term Care Medicine

Do not screen women older than 65 years for cervical cancer who have had adequate prior screening and are not otherwise at high risk of cervical cancer.

American Academy of Family Physicians

Do not perform screening for cervical cancer in low-risk women 65 years or older and in women who have had a total hysterectomy for benign disease.

American College of Preventive Medicine

Avoid colorectal cancer screening tests in asymptomatic patients with a life expectancy of less than 10 years and no family or personal history of colorectal neoplasia.

American College of Surgeons

Do not perform prostate-specific antigen testing for prostate cancer screening in men with no symptoms of the disease when they are expected to live less than 10 years.

American Society of Clinical Oncology


Source: For more information on the Choosing Wisely Campaign, see http://www.choosingwisely.org. For supporting citations and to search Choosing Wisely recommendations relevant to primary care, see http://www.aafp.org/afp/recommendations/search.htm.

The Authors

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BROOKE SALZMAN, MD, is an associate professor in the Department of Family and Community Medicine and the Division of Geriatric Medicine and Palliative Care at Thomas Jefferson University, Philadelphia, Pa....

KATHRYN BELDOWSKI, MD, is an attending physician in the Division of Geriatric Medicine at Crozer-Chester Medical Center, Upland, Pa.

AMANDA DE LA PAZ, MD, is an assistant professor in the Department of Family, Community, and Preventive Medicine at Drexel University College of Medicine, Philadelphia.

Address correspondence to Brooke Salzman, MD, Thomas Jefferson University, 211 S. 9th St., #210, Philadelphia, PA 19107 (e-mail: brooke.salzman@jefferson.edu). Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

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