BACKGROUND: Prostate-specific antigen (PSA) screening for prostate cancer remains controversial. Most groups recommend informed decision making for men with 10 years of remaining life expectancy. The primary objective of this observational cohort study was to investigate the association between predicted 9-year mortality and prostate cancer screening among American men aged 65 years in 2005 and 2010. The second objective was to analyze the proportions of men who discussed screening with their physicians. METHODS: Data were extracted from the 2005 and 2010 National Health Interview Surveys. Men aged 65 years without prostate cancer were divided into predicted 9-year mortality quartiles. The proportions of men confirming a screening PSA within the prior year were determined. Logistic regression was used to compare screening rates. RESULTS: Screening rates for men aged 65 years were 48% in 2005 and 48% in 2010 (P 5.9). Men ages 65 to 74 years who had <27% predicted 9-year mortality were most commonly screened, with 56% screened in 2010, compared with 34% of men aged 75 years with >75% predicted 9-year mortality. Approximately 55% of screened men aged 75 years who had 53% predicted 9-year mortality recalled discussing the advantages of screening, whereas 25% recalled discussing the disadvantages. CONCLUSIONS: Prostate cancer screening with PSA did not differ significantly between 2005 and 2010 for men aged 65 years based on predicted 9-year mortality. Approximately 33% of older men with a high likelihood of 9-year mortality were screened despite minimal clinical benefit. Twice as many men recalled discussing the potential advantages of screening compared with the disadvantages.

The population is aging and breast cancer incidence increases with age peaking between ages 75–79. However, it is not known if mammography screening helps women ≥75 years live longer since none of these women were included in randomized controlled trials evaluating mammography screening. Guidelines recommend that older women with <10-year life expectancy not be screened since it takes approximately 10 years before a screen-detected breast cancer may impact an older woman’s survival. For women ≥75 years with ≥10 year life expectancy, guidelines recommend that clinicians discuss the benefits and risks of screening with older women to help these women elicit their values and preferences. It is estimated that 2 out of 1,000 women that continue to be screened biennially from ages 70–79 may avoid breast cancer death. However, 12–27% of these women will experience a false positive test and 10–20% of women that experience a false positive test undergo a benign breast biopsy. In addition, approximately 30% of screen-detected cancers would not otherwise have shown up in an older woman’s lifetime. Yet nearly all older women undergo treatment for these breast cancers and the risks of treatment increase with age. To inform decision-making, tools are available to estimate patient life expectancy and to educate older women about the benefits and harms of mammography screening. In addition, guides are available to help clinicians discuss stopping screening with older women with <10 year life expectancy. Ideally, screening decisions would consider an older woman’s life expectancy, breast cancer risk, and her values and preferences.

Objectives: To examine patient perceptions of physician discussions and recommendations around total joint arthroplasty [TJA].Design: Prospective cohort study. Setting:One large academic medical center and 4 community affiliates in Boston. Participants: 174 patients aged ≥65 with severe osteoarthritis of the hip or knee for at least 6 months not controlled with medications. Measurements:Patient perceptions of primary care physicians [PCPs] and orthopedists communication about TJA were assessed at baseline for all patients and at 12 months for those that did not undergo surgery. Results:Of the 174 patients, 49 were aged ≥80; 82% were non-Hispanic white; and 69% had knee osteoarthritis. Most (87%, 142/163) reported that they had discussed their hip or knee arthritis with their PCP at baseline; 26% (42/163) reported that their PCP discussed TJA as a treatment option. Of the 128 patients that saw an orthopedist, 65% reported that their orthopedist recommended TJA. Only 29% (51/174) of patients received TJA. Those that reported discussing TJA with their PCP at baseline were more likely to undergo TJA (p<0.01). Few (36%, 44/123) of the patients who did not undergo TJA reported that their PCP discussed surgery as a treatment option at baseline or at 12 months follow-up. Author Contributions: Dr. Schonberg was involved in the study concept, analysis and interpretation of the data, and preparation of the manuscript. Dr. Marcantonio was involved in the study concept, analysis and interpretation of the data, and preparation of the manuscript. Dr. Hamel was involved in study concept and design, acquisition of subjects and/or data, analysis and interpretation of data, and preparation of the manuscript. Conflict of Interest:The authors have no conflicts of interest to report. This study was supported by the Paul Beeson Physician Faculty Scholars in Aging Research Program. Dr. Mara Schonberg was supported by a National Institute on Aging K23 award (1K23AG028584-01A1). NIH Public Access

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