Far too many older adults may be undergoing unnecessary screening for prostate and breast cancers, resulting in a significant waste in the U.S. health care system.
An article published in JAMA Oncology suggested that an estimated 15.7% of individuals 65 years or older may have received non-recommended screenings for prostate and breast cancers because they had limited life expectancies of less than 10 years.1
Existing guidelines recommend against screening for these tumors in individuals with limited life expectancy. Overdiagnosis of breast and prostate cancers may cost the U.S. health care system as much as $1.2 billion annually, according to researcher Firas Abdollah MD, who is a urology fellow with the Center for Outcomes Research, Analytics and Evaluation, at the Vattikuti Urology Institute at Henry Ford Hospital in Detroit, MI.
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“Cancer screening aims to detect tumors early, before they become symptomatic. Evidence suggests that detection and treatment of early stage tumors may reduce cancer mortality among screened individuals. Despite this potential benefit, screening programs may also cause harm. Notably, screening may identify low-risk indolent tumors that would never become clinically evident in the absence of screening, subjecting patients to the harms of unnecessary treatment,” Dr Abdollah told Cancer Therapy Advisor.
He said prostate and breast cancers are the most prevalent solid tumors in men and women and they are often slow growing.
Dr Abdollah and his coauthors analyzed data from individuals who were 65 or older, lived in the United States, and who responded to the Behavioral Risk Factors Surveillance System survey in 2012.
Of those 149 514 individuals (weighted to represent nearly 43.6 million people), there were 76 419 (51.1%) who had a prostate-specific antigen (PSA) test or mammography in the last year.
Among these individuals, 23 532 (30.8%) had a life expectancy of less than 10 years. Those figures correspond to an overall rate of non-recommended screening of 15.7% (23 532 of 149 514 individuals).
“Another important finding of our study was that there were important variations in the rate of non-recommended screening from state to state. The chance of an individual older than 65 to receive a non-recommended screening varies based on his or her geographical location in United States,” said Dr Abdollah.
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“On a state-by-state level, there was a correlation (40%) between non-recommended screening for prostate and breast cancer. The states that are more likely to offer non-recommended screening for prostate cancer are also more likely to offer non-recommended screening for breast cancer, and vice versa.” Non-recommended screening rates varied across the country from 11.6% in Colorado to 20.2% in Georgia.
