https://acpinternist.org/weekly/archives/2021/08/17/4.htm

Low-value cancer screening may be commonly provided to older U.S. adults

An observational study found that patients often continued to be screened for cervical, breast, and colorectal cancer after passing guideline-recommended age thresholds.


Older adults in the U.S. may continue to be screened for some types of cancer after they have passed the recommended age thresholds, according to a new study.

Researchers used pooled cross-sectional data from the National Ambulatory Medical Care Survey from 2011 to 2016 to estimate the frequency of cervical, breast, and colorectal cancer screening in adults who were older than the age thresholds recommended by the U.S. Preventive Services Task Force (USPSTF). Pap tests, mammograms, and colonoscopies or sigmoidoscopies were considered low value if they were performed after the age at which the USPSTF no longer considers such screening routine. The study also looked at physician- and patient-related factors associated with low-value cancer screening. Results were published Aug. 11 by the Journal of General Internal Medicine.

Overall, 37,818 women older than age 65 years and 19,451 women ages 75 years and older were included in the analyses for cervical and breast cancer screening, and 31,543 patients older than age 75 years were included in the analyses for colorectal cancer screening. Extrapolating based on screening rates in these patients, the researchers found that there were an estimated 3,056,405 (95% CI, 1,767,907 to 4,344,903) low-value Pap smears, 3,040,128 (95% CI, 1,936,360 to 4,143,895) low-value mammograms, and an estimated 1,637,591 (95% CI, 811,281 to 2,463,902) low-value colonoscopies or sigmoidoscopies provided to older patients between 2011 and 2016. Low-value cervical cancer screening was less likely for older versus younger women, and both low-value cervical and breast cancer screening were less likely in women who identified as “other race/ethnicity” (i.e., other than non-Hispanic White, non-Hispanic Black, or Hispanic) when compared with non-Hispanic White women. Low-value Pap tests and mammograms were more likely to be ordered by obstetricians/gynecologists than by family practice or general practice physicians.

The researchers noted that the data set did not include the reason a test was done and involved only office-based physicians, among other limitations. They concluded that many cervical, breast, and colorectal cancer screenings in the U.S. are conducted each year in patients older than routine guideline thresholds and that this may represent low-value care. “Additional research is needed to establish the extent to which patient/provider preferences and system-level factors (e.g., reimbursement practices, automated clinic reminders) contribute to low-value cancer screening,” the authors wrote. “It will also be important to assess whether low-value cancer screening in older adults represents clinical inertia and resistance to de-adoption of previous screening practices, or whether physicians and/or patients perceive a higher value in these tests than that endorsed by experts writing evidence-based guidelines.”