Journal of General Internal Medicine

, Volume 34, Issue 8, pp 1538–1545 | Cite as

Are We Choosing Wisely? Older Adults’ Cancer Screening Intentions and Recalled Discussions with Physicians About Stopping

  • Ashwin A. KotwalEmail author
  • Louise C. Walter
  • Sei J. Lee
  • William Dale
Original Research



National guidelines recommend against cancer screening for older individuals with less than a 10-year life expectancy, but it is unknown if this population desires ongoing screening.


To determine (1) if older individuals with < 10-year life expectancy have future intentions for cancer screening, (2) if they recall a doctor previously suggesting that screening is no longer needed, and (3) individual characteristics associated with intentions to seek screening.


National Social life Health and Aging Project (2015–2016), a nationally representative, cross-sectional survey.


Community-dwelling adults 55–97 years old (n = 3816).

Main Measures

Self-reported: (1) mammography and PSA testing within the last 2 years, (2) future intentions to be screened, and (3) discussion with a doctor that screening is no longer needed. Ten-year life expectancy was estimated using the Lee prognostic index. Multivariate logistic regression analysis examined intentions to pursue future screening, adjusting for sociodemographic and health covariates.

Key Results

Among women 75–84 with < 10-year life expectancy, 59% intend on future mammography and 81% recall no conversation with a doctor that mammography may no longer be necessary. Among men 75–84 with < 10-year life expectancy, 54% intend on future PSA screening and 77% recall no discussions that PSA screening may be unnecessary. In adjusted analyses, those reporting recent cancer screening or no recollection that screening may not be necessary were more likely to want future mammography or PSA screening (p < 0.001).


Over 75% of older individuals with limited life expectancy intend to continue cancer screening, and less than 25% recall discussing with physicians the need for these tests. In addition to public health and education efforts, these results suggest that older adults’ recollection of being told by physicians that screening is not necessary may be a modifiable risk factor for reducing overscreening in older adults with limited life expectancy.


cancer screening aging patient-centered care 



We would like to thank the National Opinion Research Center (NORC) who were responsible for data collection. The National Social Life, Health and Aging Project is supported by the National Institute on Aging and the National Institutes of Health (R01AG043538; R01AG048511; R37AG030481). Dr. Louise Walter’s effort on this project was supported by a K24 Midcareer Mentoring Award for Patient-Oriented Research in Aging (K24AG041180) from the National Institute on Aging. Dr. Sei Lee was supported by R01 AG0477897 from the National Institute on Aging and IIR 15-434 from VA HSR&D.

Compliance with Ethical Standards

All respondents provided written informed consent and the protocol was approved by the institutional review boards at the University of Chicago and National Opinion Research Center (NORC).

Conflict of Interest

The authors declare that they do not have a conflict of interest.


The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Supplementary material

11606_2019_5064_MOESM1_ESM.docx (19 kb)
ESM 1 (DOCX 18 kb)


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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Ashwin A. Kotwal
    • 1
    • 2
    Email author
  • Louise C. Walter
    • 1
    • 2
  • Sei J. Lee
    • 1
    • 2
  • William Dale
    • 3
  1. 1.Division of Geriatrics, Department of MedicineUniversity of California, San FranciscoSan FranciscoUSA
  2. 2.Geriatrics, Palliative, and Extended Care Service LineSan Francisco Veterans Affairs Medical CenterSan FranciscoUSA
  3. 3.Department of Supportive Care MedicineCity of Hope National Medical CenterDuarteUSA

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