Approximately three-quarters of surveyed physicians agreed that a life expectancy of fewer than 10 years is a reasonable criterion for discontinuing screening for common cancers. The survey study results were published as a research letter in JAMA Internal Medicine, by Nancy L Schoenborn, MD, MHS, of Johns Hopkins University in Baltimore, Maryland, and colleagues.
Dr Schoenborn and colleagues sought to explore the attitudes of physicians regarding the use of life expectancy as a reason to cease screening for breast, colorectal, and prostate cancers. To gather data on physicians’ attitudes about cessation of cancer screening in older adults, the researchers sent 1800 physicians in internal medicine, family medicine, general practice, and geriatric medicine and 600 gynecologists a survey through the mail, in addition to 2 follow-up mailings, regarding cancer screenings in adults aged 65 and older. The primary outcome of the study was whether physicians believed an estimated life expectancy of fewer than 10 years was a reasonable criterion for discontinuing cancer screening.
Of 991 survey respondents, 791 were considered eligible. Age was known for 789 respondents, of whom 22.4% were younger than 40 years, 48.2% were 40 to younger than 60 years, and 29.4% were 60 years and older.
Of the total respondents, 75.3% agreed with the position that a life expectancy of fewer than 10 years was a reasonable criterion for ceasing cancer screenings. The rate was higher among primary care physicians (81.3%).
The researchers performed a multivariable analysis to identify factors associated with attitudes regarding this criterion. In the analysis, gynecologists were less likely to agree with life expectancy as a reason to discontinue cancer screening, compared with the other specialties surveyed (odds ratio [OR], 0.41; 95% CI, 0.24-0.69); Black physicians were less likely than physicians of other races to support the criterion (OR, 0.41; 95% CI, 0.21-0.79); older physicians also were less likely to consider life expectancy as a reasonable criterion for discontinuing screening (OR, 0.77; 95% CI, 0.66-0.89 per 10 years).
The majority of respondents (64.4%) considered good patient care to include reducing overscreening. However, just 38.8% of respondents considered overscreening of older adults a substantial problem.
Nearly half the respondents who agreed that life expectancy was a reasonable criterion to discontinue screening also agreed that using this criterion could introduce a bias against persons of racial or ethnic minorities (45.4%), or against persons of low socioeconomic status (48.4%). Just 35.1% of respondents considered life expectancy prediction algorithms to be accurate enough to use in cancer-screening decisions.
“Together with a study showing that older adults do not perceive life expectancy as relevant in cancer screening, our findings question whether reframing guidelines away from the life expectancy label may be more acceptable to physicians and patients,” Dr Schoenborn and colleagues wrote in their report.
Disclosures: Some authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original study for a full list of disclosures.
Schoenborn NL, Boyd CM, Pollack CE. Physician attitudes about using life expectancy to inform cancer screening cessation in older adults — results from a national survey. JAMA Intern Med. Published online October 10, 2022. doi:10.1001/jamainternmed.2022.4316