Cancer Screening Among Older Adults Above 75 Years of Age According to Health Status: A Population-Based Study

In the absence of evidence from trials, individualized risk-based approaches to cancer screening among older adults have been advocated to overcome the constraints of age-based screening recommendations. According to these risk-based approaches, older adults with poor health or multimorbidity should be less frequently or not screened given a lower likelihood of benefit due to lower life expectancy. We aimed to describe colorectal, breast, cervical, and prostate cancer screening among older adults above the age of 75 according to health status.

Descriptive cross-sectional study analyzing the nationwide population-based 2022 Swiss Health Survey. Self-reported cancer screening in the past 12 months was assessed according to nine indicators of health status (self-rated health, chronic condition, number of morbidities, number of medications, activities of daily living, instrumental activities of daily living, functional limitations, smoking, and body mass index) with age- and sex-adjusted prevalence ratios (aPR) using modified Poisson regression.

A total of 2108 older adults were included (aged 76-80: 51%; women: 54%; tertiary education degree: 28%; multimorbidity (two or more morbidities): 49%; polypharmacy (five or more medications): 4%). The prevalence of any cancer screening in the past 12 months was 24.0% (men: 27.5%; women: 21.0%). These proportions were higher among older adults in poor health for five health status indicators but lower among those with less functional capabilities for the three corresponding indicators. Relative to older adults with no morbidity or medication use, any cancer screening was more common in those with multimorbidity (aPR for two-three morbidities: 1.40, 95% CI: 1.10-1.79; four or more morbidities: 1.66, 95% CI: 1.19-2.31) and polypharmacy (aPR: 1.54, 95% CI: 1.02-2.33).

Cancer screening is common among older adults in poor health with multimorbidity and polypharmacy. Our findings reiterate the importance of expanding evidence on personalized approaches to cancer screening among older adults.