Considerable proportion of patients with advanced cancer continue to undergo common cancer screening

October 12, 2010

A sizeable proportion of patients with advanced cancer and a life expectancy of only a few years continue to undergo common cancer screening tests that are unlikely to provide meaningful benefit, according to a study in the October 13 issue of JAMA.

Cancer screening programs, such as mammography, Papanicolaou test, prostate-specific antigen (PSA) and colonoscopy, evaluate asymptomatic patients for the detection of early forms of cancer and have contributed substantially to the decline in deaths from cancer. "Although the benefits of cancer screening are compelling for most members of the population, its value is less certain for patients with concurrent illnesses that severely limit life expectancy. In the extreme situation of patients with advanced cancer, screening will lead to over diagnosis (detection of a cancer which, if not found by active search, would not affect survival) in virtually all cases when a new malignancy is found. In addition, patients may be subject to unnecessary risk due to subsequent testing, biopsies, and psychological distress," the authors write. Current cancer screening guidelines do not directly address the appropriateness of screening for individuals with terminal illness, according to background information in the article.

Camelia S. Sima, M.D., M.S., of Memorial Sloan-Kettering Cancer Center, New York, and colleagues examined the extent to which patients with advanced cancer continue to undergo screening for new cancers and identified characteristics associated with screening. The study included data on 87,736 fee-for-service Medicare enrollees ages 65 years or older diagnosed with advanced lung, colorectal, pancreatic, gastroesophageal, or breast cancer between 1998 and 2005, and reported to one of the Surveillance, Epidemiology, and End Results (SEER) tumor registries. Participants were followed up until death or December 2007, whichever came first. A group of 87,307 Medicare enrollees without cancer were individually matched by age, sex, race, and SEER registry to patients with cancer and observed over the same period to evaluate screening rates in context. For both groups, utilization of cancer screening procedures (mammography, Papanicolaou test, PSA, and lower gastrointestinal [GI] endoscopy) was assessed. For each cancer screening test, utilization rates were defined as the percentage of patients who were screened following the diagnosis of an incurable cancer.

The researchers found that among women, following advanced cancer diagnosis compared with controls, at least 1 screening mammogram was received by 8.9 percent vs. 22.0 percent and Papanicolaou test screening was received by 5.8 percent vs. 12.5 percent. Among men with advanced cancer, 15.0 percent received PSA testing compared with 27.2 percent of controls. For all patients following advanced diagnosis compared with controls, lower GI endoscopy was received by 1.7 percent vs. 4.7 percent. Screening was more frequent among patients with a recent history of screening. Higher socioeconomic status and married status were significantly associated with a higher probability of screening for each test evaluated.

"The strongest predictor of screening in the setting of advanced cancer was the receipt of a screening test before diagnosis. The most plausible interpretation of our data is that efforts to foster adherence to screening have led to deeply ingrained habits. Patients and their health care practitioners accustomed to obtaining screening tests at regular intervals continue to do so even when the benefits have been rendered futile in the face of competing risk from advanced cancer," the authors write.

"Our results have several policy implications. First, greater awareness that screening in the face of limited life expectancy from advanced cancer is of dubious benefit may in and of itself limit use. Second, as electronic medical records and reminder systems are developed to foster screening adherence, they should also include program features that flag when conditions suggest re-evaluation or cessation of screening based on competing comorbidities. Electronic medical records increasingly have the sophistication to track cancer stage at diagnosis and disease status and to link this to screening reminder systems. Alternatively, the Medicare program might not provide coverage for cancer screening procedures for patients with life expectancy of less than 2 years."
-end-
(JAMA. 2010;304[14]:1584-1591. Available pre-embargo to the media at www.jamamedia.org)

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Please Note: For this study, there will be multimedia content available, including the JAMA Report video, embedded and downloadable video, audio files, text, documents, and related links. This content will be available at 3 p.m. CT Tuesday, October 12 at www.digitalnewsrelease.com/?q=JAMA_3760.

The JAMA Network Journals

Related Cancer Articles from Brightsurf:

New blood cancer treatment works by selectively interfering with cancer cell signalling
University of Alberta scientists have identified the mechanism of action behind a new type of precision cancer drug for blood cancers that is set for human trials, according to research published in Nature Communications.

UCI researchers uncover cancer cell vulnerabilities; may lead to better cancer therapies
A new University of California, Irvine-led study reveals a protein responsible for genetic changes resulting in a variety of cancers, may also be the key to more effective, targeted cancer therapy.

Breast cancer treatment costs highest among young women with metastic cancer
In a fight for their lives, young women, age 18-44, spend double the amount of older women to survive metastatic breast cancer, according to a large statewide study by the University of North Carolina at Chapel Hill.

Cancer mortality continues steady decline, driven by progress against lung cancer
The cancer death rate declined by 29% from 1991 to 2017, including a 2.2% drop from 2016 to 2017, the largest single-year drop in cancer mortality ever reported.

Stress in cervical cancer patients associated with higher risk of cancer-specific mortality
Psychological stress was associated with a higher risk of cancer-specific mortality in women diagnosed with cervical cancer.

Cancer-sniffing dogs 97% accurate in identifying lung cancer, according to study in JAOA
The next step will be to further fractionate the samples based on chemical and physical properties, presenting them back to the dogs until the specific biomarkers for each cancer are identified.

Moffitt Cancer Center researchers identify one way T cell function may fail in cancer
Moffitt Cancer Center researchers have discovered a mechanism by which one type of immune cell, CD8+ T cells, can become dysfunctional, impeding its ability to seek and kill cancer cells.

More cancer survivors, fewer cancer specialists point to challenge in meeting care needs
An aging population, a growing number of cancer survivors, and a projected shortage of cancer care providers will result in a challenge in delivering the care for cancer survivors in the United States if systemic changes are not made.

New cancer vaccine platform a potential tool for efficacious targeted cancer therapy
Researchers at the University of Helsinki have discovered a solution in the form of a cancer vaccine platform for improving the efficacy of oncolytic viruses used in cancer treatment.

American Cancer Society outlines blueprint for cancer control in the 21st century
The American Cancer Society is outlining its vision for cancer control in the decades ahead in a series of articles that forms the basis of a national cancer control plan.

Read More: Cancer News and Cancer Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.