A significant proportion of patients with advanced cancers continue to undergo cancer screening, even though screening is unlikely to benefit these patients. These findings were recently reported in the Journal of the American Medical Association.
Cancer screening can detect disease in its early stages, before it causes symptoms. For many people, treatment at these early stages is more likely to be effective than treatment at more-advanced stages. In this way, cancer screening is credited with a substantial decline in deaths from cancer.
For people with advanced cancer, however, the benefit of screening is questionable. Many of these patients have a limited life expectancy, making it unlikely that they would live long enough for an early-stage cancer to affect their survival. In such cases, screening without a known benefit may subject patients to risks of subsequent testing, biopsies, and psychological distress.
To evaluate the frequency of screening among patients with advanced cancer, researchers assessed 87,736 fee-for-service Medicare enrollees. Patients were aged 65 years or older and had been diagnosed with advanced lung, colorectal, pancreatic, grastroesophageal, or breast cancer between 1998 and 2003. These patients were matched by age, sex, and race with 87,307 Medicare enrollees who did not have cancer. Patients with cancer were followed until death or December 31, 2007, whichever came first. Screening tests evaluated included mammography, Pap test, PSA test, and lower gastrointestinal endoscopy.
- Among women with an advanced cancer diagnosis, 8.9% received at least one screening mammogram compared with 22% of women without cancer.
- 5.8% of women with advanced cancer received a Pap test compared with 12.5% of women without cancer.
- 15% of men with an advanced cancer diagnosis received a PSA test compared with 27.2% of men without cancer.
- Among all patients, 1.7% with advanced diagnoses received lower gastrointestinal endoscopy compared with 4.7% of those without cancer.
- Patients with advanced cancer who had a recent history of screening were more likely to undergo screening following diagnosis.
- Other factors associated with a high probability of screening were higher socioeconomic status and being married.
The researchers conclude that even though patients with advanced cancer are unlikely to benefit from screening, many of these patients continue to undergo screening. They suggest that efforts to encourage cancer screening have resulted in such “deeply engrained habits” that patients and healthcare providers maintain screening schedules among patients with advanced cancer, for whom benefit is questionable.
Reference: Sima CS, Panageas KS, Schrag D. Cancer screening among patients with advanced cancer. JAMA. 2010;304(14):1584-1591. doi:10.1001/jama.2010.1449.
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