Nonrecommended Cancer Screening Rates Remain High Among Individuals With Limited Life Expectancy

An estimated 15.7% of individuals 65 or older may have received nonrecommended screenings for prostate and breast cancer, according to a new study in JAMA Oncology. These findings could partially explain the nearly $4 billion in annual spending estimated from overdiagnosis of breast cancer alone.

The authors of the study, from the Henry Ford Health System, assessed the prevalence of nonrecommended screenings for prostate and breast cancers in patients 65 years of age or older, through a self-reported Behavioral Risk Factor Surveillance Survey conducted between January and December 2012. The primary outcome analyzed was nonrecommended screening, defined as receiving a prostate-specific antigen (PSA) test or mammography in individuals with a life expectancy less than 10 years.

The PSA screen has been given a D rating by the US Preventive Services Task Force, but urologists clearly continue to administer the test, as the current study finds. This might be because of the belief that clinicians have in the PSA test, as was evident from a presentation at the 19th annual meeting of the National Comprehensive Cancer Network, when the new prostate screening guidelines were announced. “We achieved a 45% reduction in mortality in prostate cancer in the United States, in contrast with an increase worldwide. Yet, the USPSTF gives it a D,” said Peter R. Carroll, MD, MPH, chair of the department of Urology at the University of California, San Francisco, as he presented the updated guideline.

The current study found that of 149,514 survey participants, 76,419 (51.1%) had a PSA test or mammography in the last year; 23,532 (30.8%) of those individuals had a life expectancy of less than 10 years. Those figures correspond to an overall rate of nonrecommended screening of 15.7 % (23,532 of 149,514 individuals). These screening rates varied across the country, the study found, from 11.6% in Colorado to 20.2% in Georgia. States with a high rate of nonrecommended screening for prostate cancer were also likely to have a high rate of nonrecommended screening for breast cancer and vice versa.

Limitations to the study included the possible overestimation of life expectancy and the inclusion of patients previously diagnosed, treated or observed for prostate and breast cancers.

“Efforts should be deployed to reduce nonrecommended screening in states with a high rate of nonrecommended screening. This effort may avoid significant harms to many individuals and improve the cost efficiency of screening initiatives,” the authors conclude.