Determining When to Stop Cancer Screenings

Cancer screenings may be stopped based on life expectancy rather than chronological age

(RxWiki News) There is considerable debate about the age when certain cancer screenings should begin. There may be even more debate about when cancer screenings should stop.

A new study suggests that when deciding whether or not to order a cancer screening, physicians may want to consider a patient’s life expectancy based on existing health conditions.

The authors of this study noted that cancer screenings are a complex issue and should include a patient’s preferences in the decision-making process.

"Discuss a cancer screening schedule that considers your overall health status."

Hyunsoon Cho, PhD, a researcher in the Division of Cancer Control and Population Sciences at the National Cancer Institute, and colleagues conducted this study to estimate life expectancy of individuals with no history of cancer based on comorbidities (other health conditions).

The goal of the study was to examine life expectancy as a means of helping physicians determine whether to halt or continue cancer screenings.

“The benefits associated with early detection and subsequent treatment of cancer decline sharply with age because elderly persons are more likely to die of comorbid conditions or other causes,” the researchers wrote.

Guidelines regarding when to stop screening elderly patients vary among organizations. The US Preventive Services Task Force (USPSTF), for example, recommends that colorectal cancer screening be stopped after the age of 75. But the American College of Physicians guidelines suggest taking the patient’s comorbidities and life expectancy into consideration when deciding when colorectal cancer screening is no longer worthwhile.

For this study, the researchers used Medicare data on individuals 66 years of age and older to identify comorbidities. A total of 407,749 individuals with no history of cancer were included in the study.

The scientists classified survival odds for three of the most prevalent conditions: diabetes, chronic obstructive pulmonary disease (COPD) and congestive heart failure. The US life tables were used in the calculations, and survival probabilities were classified as none, low/medium or high.

Life expectancies varied widely for each comorbidity, according to age, race and gender, the researchers discovered.

Not surprisingly, people with more comorbidities had shorter life expectancies than people of the same age who didn’t have comorbidities.

Relative to the average US population, at the age of 75, individuals without comorbidities were expected to live about three years longer.

Likewise, a 75-year-old with high comorbidity was expected to live three fewer years compared to the average US population.

Based on these findings, the researchers concluded that life expectancy may be more meaningful than chronological age in determining cancer screening strategies.

“Comorbidity-adjusted life expectancy may help physicians tailor recommendations for stopping or continuing cancer screening for individual patients,” the authors wrote.

"Even with additional information about life expectancy, discussions about continuing or stopping screening are complex and will need to be informed by patient preferences," they added.

This study was published November 18 in the Annals of Internal Medicine.

The National Institutes of Health funded this research. No potential conflicts of interest were reported.

Review Date: 
November 18, 2013