Targeting cancer prevention and screening practices for older adults

Although most cancers occur in persons aged 65 and older, objective information about the benefits of prevention, screening, and treatment are substantially lacking for older adults, because they have been largely excluded from randomized controlled trials. Proper inference about risks and benefits of cancer prevention and screening in older adults therefore requires proper interpretation of observational data. This article addresses two specific approaches to improving understanding of observational data on cancer prevention and screening in advanced age: the use of measures of risk differences (rather than relative risk) to assess varying effects of risk factors with advancing age and the use of trends over time as surrogates for screening effects. Two factors that are likely to affect cancer reduction trends in older adults in years to come are then discussed: the compression of mortality from cancers diagnosed, but not cured, at younger ages and ageism by patients, providers, and families.