Researchers Find Unnecessary Cancer Screening Pose Health Risks

While preventative testing is unlikely to benefit them, many older patients with a relatively short life expectancy are still receiving unnecessary cancer screenings. This is causing patients to become skeptical about why their physicians are ordering these tests, resulting in added medical bills and stress.

Healthy People 2020 strives to increase the percentage of people who receive cancer screenings aligned with the U.S. Preventive Services Task Force’s evidence-based principles. There is a general consensus that routine cancer screening is unnecessary for those already impacted by chronic health problems.

The study’s authors used data from the National Health Interview Survey from 2000 to 2010 to examine rates of cervical, breast, prostate and colorectal cancer screening in patients aged 65 and older. A total of 27,404 patients were included in the study, and categorized by their nine-year mortality risk.

Unnecessary cancer screening

Researchers found that 31 to 55 percent of patients with a very high mortality risk had recently received cancer screening ─ with prostate testing as the most prevalent. A total of 34 to 56 percent of women who had underwent a hysterectomy for benign reasons were given the Papanicolaou test within the past three years. In total, an average of 64 percent of patients were screened for prostate cancer, 63 percent for breast cancer, 57 percent for cervical cancer and 47 percent for colorectal cancer. Recent years had seen less screening for prostate and cervical cancer than in 2000. Older age was found to be a common denominator for less screening for all types of cancer. Patients more likely to receive screening for these types of cancers were highly educated, insured, married or regularly visited the same physician had a greater chance of being screened.

“These results raise concerns about overscreening in these individuals, which not only increases health care expenditure but can lead to patient net harm. Creating simple and reliable ways to assess life expectancy in the clinic may allow reduction of unnecessary cancer screening, which can benefit the patient and substantially reduce health care costs. There is considerable need for further dissemination efforts to educate physicians and patients regarding the existing screening guidelines and potential net harm from screening in individuals with limited life expectancy,” writes Trevor J. Royce, M.D., M.S., University of North Carolina at Chapel Hill, and his colleagues wrote in their JAMA Internal Medicine article.

Increased cancer screening may cause more harm than good

Dutch researcher Frank van Hees, M.Sc., of Erasmus University Medical Center, the Netherlands and his colleagues published the study, “Modeling Study Analyzes Colonoscopy Screening of Medicare Patients,” finding that unnecessary screening Medicare patients with colonoscopies may be more harmful than beneficial. The simulated modeling study found that more screenings than recommended produced only small increases in preventing colorectal cancer deaths, but led to large increases in complications.

Cary P. Gross, M.D., of the Yale University School of Medicine writes, “Cancer screening in the 21st century, however, is losing its luster. Increasing evidence suggests that many modalities of cancer screening may be far less beneficial than first thought.”

“It is particularly important to question screening strategies for older persons. Patients with a shorter life expectancy have less time to develop clinically significant cancers after a screening test and are more likely to die from non-cancer health problems after a cancer diagnosis,” writes Dr. Gross.

“In addition, older persons face a higher risk of complications from procedures such as screening colonoscopy.”