After age 75, routine screening is no longer recommended for cervical, prostate, breast, and colorectal cancers. But that inconvenient truth hasn't stopped older Americans from continuing to get the tests, according to a study appearing today in the Archives of Internal Medicine.
More than half of a racially diverse population of nearly 50,000 individuals older than 75 continued to get screening exams for the four cancers included in the study, the results showed. One major reason is because more than 50% of physicians continue to recommend them in older men and women, despite the recommendations of experts (Arch Intern Med, December 12-26, 2011, Vol. 171:22, pp. 2031-2037).
"A person's recollection of a physician's recommendation for screening was a significant predictor of screening behavior," wrote Keith Bellizzi, PhD, and colleagues from the National Cancer Institute, along with investigators from Information Management Services in Silver Spring, MD. "This finding reinforces the critical role for healthcare providers to make informed screening decisions for older adults."
U.S. Preventive Services Task Force (USPSTF) screening guidelines suggest there is insufficient evidence to recommend screening for individuals older than 75 years, although there is "growing recognition" that such tests may continue to benefit patients despite the paucity of published data, Bellizzi and colleagues noted.
The study analyzed data from the National Health Interview Survey, an in-person survey used to track U.S. health trends. The sample included 49,575 individuals, including 1,697 ages 75 to 79 and 2,376 ages 80 and older. The researchers examined screening behavior and compared it to USPSTF guidelines.
Among adults ages 75 to 79 years, the percentage of patients screened was 57% for colorectal cancer, 62% for breast cancer, 53% for cervical cancer, and 56% for prostate cancer, the group reported. Even among patients older than 80 years, screening participation ranged from 38% for cervical cancer to 50% for breast cancer.
A physician's recommendation was the largest predictor of screening for any particular exam, and more than half of men and women ages 75 years and older said their physicians continue to recommend screening.
The results also suggest that older minority adults from certain racial groups, perhaps due to lower education levels, continue to be screened less frequently than older whites. Logistic regression showed a correlation between higher education attainment and significantly higher screening prevalence.
Those without high school diplomas were significantly less likely to be screened for breast (odds ratio [OR] = 0.4; 95% confidence interval [CI]: 0.3-0.7), cervical (OR = 0.4; 95% CI: 0.2-0.8), colorectal (OR = 0.5; 95% CI: 0.3-0.8), and prostate (OR = 0.5; 95% CI: 0.3-0.8) cancer, compared with individuals older than 75 years who had a college degree.
Offering high-quality care to increasing numbers of older adults will pose significant challenges and calls for evidence-based decision-making, the authors wrote. Data on outcomes in this population will contribute to a better understanding of the need for screening.
