Among persons 65 years or older with limited life expectancies of less than 10 years, an estimated 15.7% may have undergone nonrecommended screenings for prostate and breast cancers. These findings were published in JAMA Oncology (doi:10.1001/jamaoncol.2015.5871).
For persons with limited life expectancy, existing guidelines recommend against screening for these tumors. The cost of overdiagnosis on the US health care system may be as much as $1.2 billion.
The prevalence of nonrecommended screenings for prostate and breast cancers was assessed by Firas Abdollah, MD, of the Henry Ford Health System, Detroit, Michigan, and coauthors. All those who responded to the Behavioral Risk Factors Surveillance System survey in 2012, lived in the United States, and were 65 years or older were included in the analysis.
The study included 149 514 participants (weighted to represent nearly 43.6 million people). Among them, 76 419 (51.1%) underwent a prostate-specific antigen (PSA) test or mammography in the last year; yet 23 532 (30.8%) of those participants had a life expectancy of less than 10 years. Those figures correspond to an overall rate for nonrecommended screening of 15.7% (23 532 of 149 514 participants).
Rates of nonrecommended screening varied across the country from 11.6% in Colorado to 20.2% in Georgia. States in which nonrecommended screening rates were high for one type of cancer—prostate cancer or breast cancer—high rates were also high for the other cancer type.
Possible overestimations of life expectancies and inclusion of patients previously diagnosed, treated, or observed for prostate and breast cancers were reported study limitations.
Efforts are needed to reduce rates of nonrecommended screening in states in which their rates are high. The effort may avoid significant harms to many patients and improve the cost efficiency of screening initiatives, concluded the researchers.