Association Between Receipt of Cancer Screening and All-Cause Mortality in Older Adults

Schoenborn, Nancy L.; Sheehan, Orla C.; Roth, David L.; Cidav, Tansu; Huang, Jin; Chung, Shang En; Zhang, Talan; Lee, Sei; Xue, Qian; Boyd, Cynthia M.

doi:10.1001/jamanetworkopen.2021.12062

Cited by 7 publications

(7 citation statements)

References 40 publications

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“…While in aggregate, low-value cancer screenings may pose greater risk than benefit, testing outside established recommendations must be individualized, as algorithmic decisions may misclassify patients otherwise appropriate for screening. 60 Clinicians should engage in shared decision-making with those patients. Communication strategies, decision aides, and conceptual frameworks for these challenging conversations have been proposed, supported by the American Cancer Society and the US Preventive Services Task Force.…”

Section: Discussionmentioning

confidence: 99%

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Factors Associated With Low-Value Cancer Screenings in the Veterans Health Administration

et al. 2021

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IMPORTANCEMost clinical practice guidelines recommend stopping cancer screenings when risks exceed benefits, yet low-value screenings persist. The Veterans Health Administration focuses on improving the value and quality of care, using a patient-centered medical home model that may affect cancer screening behavior. OBJECTIVE To understand rates and factors associated with outpatient low-value cancer screenings. DESIGN, SETTING, AND PARTICIPANTS This cohort study assessed the receipt of low-value cancer screening and associated factors among 5 993 010 veterans. Four measures of low-value cancer screening defined by validated recommendations of practices to avoid were constructed using administrative data. Patients with cancer screenings in 2017 at Veterans Health Administration primary care clinics were included. Excluded patients had recent symptoms or historic high-risk diagnoses that may affect test appropriateness (eg, melena preceding colonoscopy). Data were analyzed from December 23, 2019, to June 21, 2021. EXPOSURES Receipt of cancer screening test. MAIN OUTCOMES AND MEASURES Low-value screenings were defined as occurring for averagerisk patients outside of guideline-recommended ages or if the 1-year mortality risk estimated using a previously validated score was at least 50%. Factors evaluated in multivariable regression models included patient, clinician, and clinic characteristics and patient-centered medical home domain performance for team-based care, access, and continuity previously developed from administrative and survey data. RESULTS Of 5 993 010 veterans (mean [SD] age, 63.1 [16.8] years; 5 496 976 men [91.7%]; 1 027 836 non-Hispanic Black [17.2%] and 4 539 341 non-Hispanic White [75.7%] race and ethnicity) enrolled in primary care, 903 612 of 4 647 479 men of average risk (19.4%) underwent prostate cancer screening; 299 765 of 5 770 622 patients of average risk (5.2%) underwent colorectal cancer screening; 21 930 of 469 045 women of average risk (4.7%) underwent breast cancer screening; and 65 511 of 458 086 women of average risk (14.3%) underwent cervical cancer screening. Of patients screened, low-value testing was rare for 3 cancers, with receipt of a low-value test in 633 of 21 930 of women screened for breast cancer (2.9%), 630 of 65 511 of women screened for cervical cancer (1.0%), and 6790 of 299 765 of patients screened for colorectal cancer (2.3%). However, 350 705 of 4 647 479 of screened men (7.5%) received a low-value prostate cancer test. Patient race and ethnicity, sociodemographic factors, and illness burden were significantly associated with likelihood of receipt of low-value tests among screened patients. No single patient-, clinician-, or clinic-level factor explained the receipt of a low-value test across cancer screening cohorts.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Factors Associated With Low-Value Cancer Screenings in the Veterans Health Administration

et al. 2021

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“…It also emphasizes the need for providers to have candid conversations with their patients regarding life expectancy as this knowledge affects women's willingness to undergo screening. A recently published study by Schoenborn et al showed that there still clearly is an important role for screening mammography to reduce 10-year allcause mortality, even when adjusted for various health comorbidities and functional status [26].…”

Section: Discussionmentioning

confidence: 99%

Hospitalized Women’s Perspective on Willingness-to-Screen for Cancers in Relation to Life Expectancy

Shubella¹,

Kauffman²,

Khaliq³

2022

Cureus

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Objective: Life expectancy is an important tool for physicians and patients to determine when medical services for disease prevention should be rendered. Since patients' preference is an important predictor for cancer screening compliance, incorporating life expectancy with cancer screening preferences becomes essential. The purpose of the study is to explore the mean life expectancy duration that hospitalized women expect in order to undergo cancer screening tests.Methods: A cross-sectional bedside survey including the contingent valuation method was used to assess the mean life expectancy among 475 cancer-free hospitalized women aged 50-75 years, which justified their willingness to undergo cancer screening tests. The probit and logistic regression models were used for the analysis in October 2021.Results: A total of 74% of women were willing to undergo cancer screening if the mean life expectancy was 24.3 months (SE = 12.8, p = 0.058). After adjustment for sociodemographic and clinical covariates, hospitalized women were willing to undergo cancer screening if the mean life expectancy was 26.6 months (SE = 13.3, p = 0.045). Race (African American and others vs Caucasians, OR = 2.34, 95% CI: 1.43-3.81) and annual household income <$20,000 (OR = 1.71, 95% CI: 1.02-2.86) were associated with the willingness to undergo cancer screening among hospitalized women.Conclusion: The study's findings suggest that hospitalized women value the prospect of cancer screening tests, given the mean life expectancy of approximately 27 months. Therefore, offering screening tests to nonadherent hospitalized women with a mean life expectancy of 2¼ years, especially to those at high risk for developing cancer, with low income, or women of color, may improve adherence to cancer screening recommendations.

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“…34 An analysis of outcomes in women older than 65 years found that, even after correcting for prognostic index and potential confounders, breast cancer screening was associated with reduced all-cause mortality. 35 This screening benefit was attenuated but persisted in women with reduced cognition. The authors of this analysis suggest that current algorithms might misclassify individuals as having a low life expectancy, resulting in cessation of screening that is inappropriately premature.…”

Section: Clinical Trends In De-implementation In Low-risk Breast Cancer In Older Womenmentioning

confidence: 99%

“… 41 , 42 Compounding the sparse data on cancer risk in older patients is the scarcity of evidence on the benefits of enhanced surveillance and risk-reducing strategies. Although intensive surveillance has the potential to lead to early detection, 35 the effect on survival outcomes in older people is largely unknown. Furthermore, although there is an increased risk of developing a second breast cancer in patients with a pathogenic variant in BRCA1 or BRCA2 , contralateral risk-reducing mastectomy is unlikely to confer a survival benefit.…”

Section: Clinical Trends In De-implementation In Low-risk Breast Cancer In Older Womenmentioning

confidence: 99%

Personalising therapy for early-stage oestrogen receptor-positive breast cancer in older women

Carleton

Nasrazadani

Gade

et al. 2022

The Lancet Healthy Longevity

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Age is one of the most important risk factors for the development of breast cancer. Nearly a third of all breast cancer cases occur in older women (aged ≥70 years), with most cases being oestrogen receptor-positive (ER+). Such tumours are often indolent and unlikely to be the ultimate cause of death for older women, particularly when considering other comorbidities. This Review focuses on unique clinical considerations for screening, detection, and treatment regimens for older women who develop ER+ breast cancers—specifically, we focus on recent trends for de-implementation of screening, staging, surgery, and adjuvant therapies along the continuum of care. Additionally, we also review emerging basic and translational research that will further uncover the unique underlying biology of these tumours, which develop in the context of systemic age-related inflammation and changing hormone profiles. With prevailing trends of clinical de-implementation, new insights into mechanistic biology might provide an opportunity for precision medicine approaches to treat patients with well tolerated, low-toxicity agents to extend patients’ lives with a higher quality of life, prevent tumour recurrences, and reduce cancer-related burdens.

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Association Between Receipt of Cancer Screening and All-Cause Mortality in Older Adults

Cited by 7 publications

References 40 publications

Factors Associated With Low-Value Cancer Screenings in the Veterans Health Administration

Factors Associated With Low-Value Cancer Screenings in the Veterans Health Administration

Hospitalized Women’s Perspective on Willingness-to-Screen for Cancers in Relation to Life Expectancy

Personalising therapy for early-stage oestrogen receptor-positive breast cancer in older women

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