Prostate cancer screening still common in older men

A significant number of older men with limited life expectancy continue to undergo routine prostate cancer screening, researchers say.

Study authors, who examined screening rates for prostate, breast, cervical, and colorectal cancer, found that prostate cancer screening was the most common type of screening in patients with very high mortality risk. More than half of men (55%) with less than a 9-year life expectancy were screened for prostate cancer.

Study findings were published online in JAMA Internal Medicine (Aug. 18, 2014).

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“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,” wrote the authors, led by first author Trevor J. Royce, MD., MS, of the University of North Carolina at Chapel Hill.

He and colleagues examined rates of cancer screening in patients age 65 years or older using data from the National Health Interview Survey from 2000 through 2010. The study included 27,404 participants who were grouped by risk (low to very high) of 9-year mortality. Low mortality risk was defined as less than 25% and very high mortality risk was 75% or more.

The overall screening rate was highest for prostate cancer at 64%, ranging from 70% in men with low mortality risk to 55% in those with very high mortality risk. There was less screening for prostate and cervical cancers in more recent years compared with 2000. Older age was associated with less screening for all cancers.

Patients who were married, had more education, had insurance, or had a usual place for care were more likely to be screened.

In an accompanying commentary also appearing in JAMA Internal Medicine, Cary P. Gross, MD, of the Yale University School of Medicine, wrote: “It truly will be a new era when providers will be evaluated, in part, by their ability to refrain from ordering cancer screening tests for some of their patients. We are moving toward a time when prevention efforts will be more evidence based, more effective and patient centered. What could be more wonderful than that?”

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