Credit must be given to Charles Bankhead, a staff writer at MedPage Today for taking on a very difficult subject whether it makes any sense to perform cancer screens on seniors, and if so, when. While this may conjure up images of death squads or health care rationing, it is actually an important, pragmatic, and timely topic.
And this is not simply about cost savings. It is mostly about whether it makes sense to do certain tests regardless of cost. Are they useful? Do they do more harm than good?
In his piece entitled Cancer Screening in Seniors Yields Few Benefits, Bankhead makes it quite clear how he feels about this. He cites two recent studies that examine just this. His conclusion is rather obvious based on the two action points cited in the article:
- Note that a survey-based study revealed that rates of screening for cancer decrease as life-expectancy decreases, but remain very high.
- Be aware that overscreening of those at high risk of mortality can lead to unnecessary expenditure and a risk of invasive procedures.
Two studies formed the basis of these conclusion. Both were based on pooled data from the National Health Interview Survey (NHIS), which was conducted between 2000 and 2010.
The first study was published online in JAMA Internal Medicine, by Ronald C. Chen, MD, MPH, of the University of North Carolina at Chapel Hill, and colleagues. The investigators concluded: "A substantial proportion of the U.S. population with limited life expectancy received prostate, breast, cervical, and colorectal cancer screening that is unlikely to provide net benefit."
Screening rates were obtained for four types of cancer in more than 27,000 people, aged 65 and older. The results showed that even for patients with a very high risk of death, screening rates ranged from 31 percent (cervical cancer) to 55 percent (prostate cancer) very high rates for patients who are elderly, and thus have shorter life spans, and may very well already be very ill from their cancers.
A second study showed that increasing the time interval from 5 to 10 years for screening colonoscopy would have a minimal effect. The authors concluded that [This] would lead to a minimal gain in quality-adjusted life years (QALYs) at a cost exceeding $700,000 per QALY. In other words, a lot of money spent on screening that provides no tangible benefit.
Furthermore, the study uncovered more than a few cases of absurd screening, such as giving a Pap test to women who had already had a hysterectomy. Does this make any sense? Not according to the Mayo Clinic, which says You can stop having Pap smears, however, if you had a total hysterectomy for a noncancerous condition.
ACSH s Dr. Josh Bloom says, The 'must screen for everything' mantra has been ingrained in our minds for many years, yet the actual benefits from routine screens, such as PSA for prostate cancer and routine mammography for prevention of breast cancer, are increasingly being questioned. Although more screening will necessarily pick up more cancers, it will also set off many more false alarms, some of which will put people into the system, where they will be subjected to more tests. Some of these tests will be invasive and will ultimately do more harm than good.
In an accompanying commentary, Cary P. Gross, MD, of Yale University School of Medicine says that cancer screening is losing its luster: "Cancer screening in the 21st century ...Increasing evidence suggests that many modalities of cancer screening may be far less beneficial than first thought."
Dr. Bloom says, When medical dogma changes, it is often difficult for people to accept this. Some people who already have serious cancers will still want to be (and are) screened for other cancers. They may think that more testing equals better results, and that they are somehow being cheated out of the best medical treatment if they do not receive all the available tests. I suspect it will take quite some time for the general population to accept this new reality as it continues to develop.