He said the study has significant limitations, including the possible overestimation of life expectancy and the inclusion of patients previously diagnosed, treated, or observed for prostate and breast cancers.
Dr Abdollah said explaining the concept of life expectancy to patients can prove to be very challenging. Much more research is warranted and further investigation is necessary to increase the accuracy of the currently available life expectancy calculators.
“Besides the economic burden, overdiagnosis and overtreatment may result in a significant increase in patients’ physical and psychological morbidity. Our study shows that there is a lot of space for improvement at a national level, as well as at state level. This improvement can’t be achieved without a multi-disciplinary effort, including primary care physicians, surgeons, and oncologists,” said Dr Abdollah.
Lodovico Balducci, MD, who is the Senior Adult Oncology Program leader at Moffitt Cancer Center, Tampa, FL, said there is no question that screening women for breast cancer saves some lives. He said screening mammography has been shown to be beneficial up to age 85—even in the presence of moderate comorbidity.
“The question is how much screening is enough and how much screening is too much. For example, mammography every 2 years may be as effective as yearly mammography, and it is possible that yearly breast examination by a physician or a nurse may be sufficient for older women with shrinking breasts. These issues should be studied with the aging of the population to improve the value of screening,” Dr Balducci told Cancer Therapy Advisor.
“For prostate cancer, yearly screening with PSA has reduced the cancer-related but not the overall mortality of men up to age 65 and there is no evidence of benefits in older men, so I would not recommend it as a practice.”
However, Dr Balducci said there are good reasons to believe that screening for prostate cancer may become beneficial with the aging of the population due to increases in life expectancy and new non-invasive diagnostic techniques.
He noted that multiparametric magnetic resonance imaging of the prostate may reduce the number of biopsies necessary to diagnose prostate cancer. In addition, new forms of treatment, such as intensity-modulated radiation therapy and proton therapy, are much safer and well tolerated by older individuals.
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“The value of screening needs to be assessed in a dynamic fashion, considering that the population is aging and the diagnostic and therapeutic techniques undergo progressive improvement. The discussion of cost needs to take into account how much it would have cost to manage the cancer deaths that were prevented from screening,” said Dr Balducci.
- Abdollah F, Sun M, Sammon JD, et al. Prevalence of nonrecommended screening for prostate cancer and breast cancer in the United States: a nationwide survey analysis [published online ahead of print January 21, 2016]. JAMA Oncol. doi:10.1001/jamaoncol.2015.5871.