Cancer Screening in the Elderly

Abstract

There is relatively limited data on outcomes of screening older adults for cancer; therefore, the decision to screen older adults requires balancing the potential harms of screening and follow-up diagnostic tests with the possibility of benefit. Harms of screening can be amplified in older and frail adults, and include discomfort from undergoing the test itself, anxiety, potential complications from diagnostic procedures resulting from a false-positive test, false reassurance from a false-negative test, and overdiagnosis of tumors that are of no threat and may result in overtreatment. In this paper, we review the evidence and guidelines on breast, colorectal, lung and prostate cancer as applied to older adults. We also provide a general framework for approaching cancer screening in older adults by incorporating evidence-based guidelines, patient preferences, and patient life expectancy estimates into shared screening decisions.

Demographic, health, and attitudinal factors predictive of cancer screening decisions in older adults

“…In this national sample, participants with favorable attitude towards screening represented about one-third of the total sample. This has important implications since a sizable subset of older adults may have persistent beliefs and attitudes that lead to screening despite older age or short life expectancy, which are thresholds outlined in guidelines for stopping routine screening (Harris et al, 2015; Kotwal and Schonberg, 2017).…”

“…However, it also may cause harms, including false positive results and over-diagnosis of clinically unimportant cancers (Eckstrom et al, 2013). Clinical practice guidelines recommend against routine cancer screening when the harms outweigh the benefits, often defined using age or life expectancy thresholds (Harris et al, 2015; Kotwal and Schonberg, 2017). Many older adults for whom routine cancer screening is no longer recommended still receive screening for breast, colorectal, and prostate cancers (Royce et al, 2014).…”

Effect of miR-21 on Apoptosis in Lung Cancer Cell Through Inhibiting the PI3K/ Akt/NF-κB Signaling Pathway in Vitro and in Vivo

“…Additionally, the incidence of lung cancer has already ranked first in male malignancies [4, 5]. Apoptosis is the process of an autonomously and orderly death of cells controlled by genes, and it plays a major role in the maintenance of the internal stability of cells [6-8].…”

Preferred Clinician Communication About Stopping Cancer Screening Among Older US Adults

“…Clinical practice guidelines recommend against routine cancer screening in older adults in whom the potential harms of screening outweigh the benefits, which are often defined by specific age or life expectancy thresholds. 1,2 However, many older adults who meet these thresholds for stopping routine screening continue to undergo screening for breast, prostate, and colorectal cancers. 3 One contributor to this discrepancy may be that clinicians are uncomfortable discussing cancer screening cessation.…”