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Related Experiment Videos

When should we stop screening?

J S Rich1, W C Black

  • 1VA Outcomes Group, White River Junction, Vt., USA. james.scott.rich@hitchcock.org

Effective Clinical Practice : ECP
|August 1, 2000
PubMed
Summary
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Stopping cancer screenings like mammography, fecal occult blood testing, and Pap smears in older adults yields minimal life expectancy gains. The potential harms of continued screening in the elderly may outweigh the small benefits.

Area of Science:

  • Oncology
  • Geriatrics
  • Preventive Medicine

Background:

  • Debate exists regarding the optimal age to initiate cancer screening.
  • Little attention has been given to determining the appropriate age to discontinue cancer screening.

Purpose of the Study:

  • To calculate the potential life expectancy lost by stopping cancer screening at various ages.
  • To evaluate the benefits versus harms of continuing cancer screening in the elderly population.

Main Methods:

  • Life tables were used to calculate life expectancy for continuing versus stopping screening for breast, cervical, and colon cancer.
  • Mortality data were sourced from the National Center for Health Statistics and SEER.
  • Assumed a 30% mortality reduction for breast and colon cancer screening, and 30-70% for cervical cancer screening, persisting in the elderly.

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Main Results:

  • Continuing screening throughout life offers a maximum of 43 days benefit for breast cancer and 28 days for colon cancer (starting at age 50).
  • Stopping screening at age 75 results in a loss of 9 days (mammography/fecal occult blood testing) or 3 days (Pap smear, best-case).
  • Stopping screening at age 80 results in a loss of 5 days (mammography/fecal occult blood testing) or 1.5 days (Pap smear, best-case).

Conclusions:

  • Significant benefits of cancer screening are achieved before age 75 for breast cancer, 80 for colon cancer, and 65 for cervical cancer.
  • The marginal benefits of screening in the elderly may be surpassed by potential harms, including anxiety, further testing, and unnecessary treatments.