Cancer Screening in Elderly Patients: A Framework for Individualized Decision Making
Abstract
Considerable uncertainty exists about the use of cancer screening tests in older people, as illustrated by the different age cutoffs recommended by various guideline panels. We suggest that a framework to guide individualized cancer screening decisions in older patients may be more useful to the practicing clinician than age guidelines. Like many medical decisions, cancer screening decisions require weighing quantitative information, such as risk of cancer death and likelihood of beneficial and adverse screening outcomes, as well as qualitative factors, such as individual patients' values and preferences. Our framework first anchors decisions through quantitative estimates of life expectancy, risk of cancer death, and screening outcomes based on published data. Potential benefits of screening are presented as the number needed to screen to prevent 1 cancer-specific death, based on the estimated life expectancy during which a patient will be screened. Estimates reveal substantial variability in the likelihood of benefit for patients of similar ages with varying life expectancies. In fact, patients with life expectancies of less than 5 years are unlikely to derive any survival benefit from cancer screening. We also consider the likelihood of potential harm from screening according to patient factors and test characteristics. Some of the greatest harms of screening occur by detecting cancers that would never have become clinically significant. This becomes more likely as life expectancy decreases. Finally, since many cancer screening decisions in older adults cannot be answered solely by quantitative estimates of benefits and harms, considering the estimated outcomes according to the patient's own values and preferences is the final step for making informed screening decisions.
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- Authors
- Walter, L. C., & Covinsky, K. E.
- Affiliations
- San Francisco VA Medical Center (US)
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2001-06-06
- Volume
- 285
- Issue
- 21
- Pages
- 2750
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W1978229612
- Cited by
- 1,003
- References
- 58
- Citations by year
- 2026: 19 · 2025: 23 · 2024: 14 · 2023: 29 · 2022: 32 · 2021: 31 · 2020: 89 · 2019: 36 · 2018: 38 · 2017: 35 · 2016: 57 · 2015: 43 · 2014: 56 · 2013: 53 · 2012: 76
- FWCI
- 9.26
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- DigitalGeorgetown (Georgetown University Library) (submittedVersion)
- Funders
- Agency for Healthcare Research and Quality (K02 HS 00006-01)
- U.S. Public Health Service
- Topics
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Keywords
- cancer screening, older adults, age cut-off, life expectancy, cancer-specific mortality, number needed to screen, screening harms, overdiagnosis, patient values and preferences, individualized decision-making, screening guidelines
- MeSH terms
- Aged, Aged, 80 and over, Decision Making, Female, Health Services for the Aged, Humans, Life Expectancy, Male, Mass Screening, Middle Aged, Neoplasms, Risk, Geriatric Assessment, Practice Guidelines as Topic, Risk Assessment
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