Advertisement

Cancer Screening in Older Adults

  • Louise C. Walter
Chapter

This chapter focuses on the special issues that need to be considered when making decisions to screen older persons for cancer. Specifically, while there is substantial evidence that screening for colorectal, breast, and cervical cancer reduces cancer mortality among persons in their 50s and 60s [1–6], few screening trials included persons over age 70. Therefore, clinicians must assess whether to extrapolate results from screening trials to their older patients. To determine the appropriateness of this extrapolation, clinicians need to know whether there are differences in the behavior of cancers in older people that change the benefit of early detection and treatment; whether there are differences in the accuracy of screening tests in older people that make the tests more or less likely to miss cancer; and whether there are differences among older individuals that alter the likelihood of receiving benefit versus harm from cancer screening [7]. The need to individualize cancer screening decisions is especially important for older persons, because individuals become increasingly unique in their particular combination of health, life expectancy, and values with advancing age.

Keywords

Cervical Cancer Cancer Screening Human Papilloma Virus Fecal Occult Blood Testing Cervical Cancer Screening 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    U.S. Preventive Services Task Force. Screening for colorectal cancer: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med 2008;149:627–37.Google Scholar
  2. 2.
    Smith RA, Cokkinides V, Eyre HJ. Cancer screening in the United States, 2007: A review of current guidelines, practices, and prospects. CA Cancer J Clin 2007;57:90–104.PubMedCrossRefGoogle Scholar
  3. 3.
    U.S. Preventive Services Task Force. Screening for breast cancer: Recommendations and rationale. Ann Intern Med 2002;137:344–6.Google Scholar
  4. 4.
    American Geriatrics Society Clinical Practice Committee. Breast cancer screening in older women. J Am Geriatr Soc 2000;48:842–4.Google Scholar
  5. 5.
    U.S. Preventive Services Task Force. Screening for cervical cancer. http://www.ahrq.gov/clinic/3rduspstf/cervcan/cervcanrr.htm. Accessed Apr. 28, 2008.
  6. 6.
    American Geriatrics Society. Screening for cervical cancer in older women. J Am Geriatr Soc 2001;49:655–7.Google Scholar
  7. 7.
    Walter LC, Lewis CL, Barton MB. Screening for colorectal, breast, and cervical cancer in the elderly: A review of the evidence. Am J Med 2005;118:1078–86.PubMedCrossRefGoogle Scholar
  8. 8.
    Walter LC, Covinsky KE. Cancer screening in elderly patients: A framework for individualized decision making. J Am Med Assoc 2001;285:2750–6.CrossRefGoogle Scholar
  9. 9.
    National Center for Health Statistics. Life Tables of the United States, 2001. Available at http://www.cdc.gov/nchs/data/dvs/lt2001.pdf. Accessed Apr. 28, 2008.
  10. 10.
    Lee SJ, Lindquist K, Segal MR, Covinsky KE. Development and validation of a prognostic index for 4-year mortality in older adults. J Am Med Assoc 2006;295:801–8.CrossRefGoogle Scholar
  11. 11.
    Walsh JME, Terdiman JP. Colorectal cancer screening: Scientific review. J Am Med Assoc 2003;289:1288–96.CrossRefGoogle Scholar
  12. 12.
    Pignone M, Rich M, Teutsch SM, et al. Screening for colorectal cancer in adults at average risk: A summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 2002;137:132–41.PubMedGoogle Scholar
  13. 13.
    Hardcastle JD, Chamberlain JO, Robinson MH, et al. Randomised controlled trial of faecal-occult blood screening for colorectal cancer. Lancet 1996;348:1472–7.PubMedCrossRefGoogle Scholar
  14. 14.
    Kronborg O, Fenger C, Olsen J, et al. Randomised study of screening for colorectal cancer with faecal-occult-blood test. Lancet 1996;348:1467–71.PubMedCrossRefGoogle Scholar
  15. 15.
    Mandel JS, Bond JH, Church TR, et al. Reducing mortality from colorectal cancer by screening for fecal occult blood. N Engl J Med 1993;328:1365–71.PubMedCrossRefGoogle Scholar
  16. 16.
    Selby JV, Friedman GD, Quesenberry CP, Weiss NS. A case-control study of screening sigmoidoscopy and mortality from colorectal cancer. N Engl J Med 1992;326:653–7.PubMedCrossRefGoogle Scholar
  17. 17.
    Muller AD, Sonnenberg A. Protection by endoscopy against death from colorectal cancer: A case-control study among veterans. Arch Intern Med 1995;155:1741–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Levin B, Lieberman DA, McFarland B, et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: A joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA Cancer J Clin 2008;58:130–60.PubMedCrossRefGoogle Scholar
  19. 19.
    Lieberman DA, Weiss DG, Bond JH, et al. Use of colonoscopy to screen asymptomatic adults for colorectal cancer. N Engl J Med 2000;343:162–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Stryker SJ, Wolff BG, Culp CE, et al. Natural history of untreated colonic polyps. Gastroenterology 1987;93:1009–13.PubMedGoogle Scholar
  21. 21.
    Robinson MHE, Hardcastle JD, Moss SM, et al. The risks of screening: Data from the Nottingham randomized controlled trial of faecal occult blood screening for colorectal cancer. Gut 1999;45:588–92.PubMedCrossRefGoogle Scholar
  22. 22.
    Parker MA, Robinson MHE, Scholefield JH, Hardcastle JD. Psychiatric morbidity and screening for colorectal cancer. J Med Screen 2002;9:7–10.PubMedCrossRefGoogle Scholar
  23. 23.
    Sargent DJ, Goldberg RM, Jacobson SD, et al. A pooled analysis of adjuvant chemotherapy for resected colon cancer in elderly patients. N Engl J Med 2001;15:1091–7.CrossRefGoogle Scholar
  24. 24.
    Imperiale TF, Wagner DR, Lin CY, et al. Using risk for advanced proximal colonic neoplasia to tailor endoscopic screening for colorectal cancer. Ann Intern Med 2003;139:959–65.PubMedGoogle Scholar
  25. 25.
    Ransohoff DF, Lang CA. Screening for colorectal cancer with fecal occult blood test: A background paper. Ann Intern Med 1997;126:811–22.PubMedGoogle Scholar
  26. 26.
    Tabar L, Vitak B, Chen H, et al. The Swedish Two-County Trial twenty years later. Radiol Clin N Am 2000;38:625–51.PubMedCrossRefGoogle Scholar
  27. 27.
    Thomas DB, Gao DL, Ray RM, et al. Randomized trial of breast self-examination in Shanghai: Final results. J Natl Cancer Inst 2002;94:1445–57.PubMedCrossRefGoogle Scholar
  28. 28.
    Welch HG, Fisher ES. Diagnostic testing following screening mammography in the elderly. J Natl Cancer Inst 1998;90:1389–92.PubMedCrossRefGoogle Scholar
  29. 29.
    Bobo JK, Lee NC, Thames SF. Findings from 752081 clinical breast examinations reported to a national screening program from 1995 through 1998. J Natl Cancer Inst 2000;92:971–6.PubMedCrossRefGoogle Scholar
  30. 30.
    Ernster VE, Ballard-Barbash R, Barlow WE, et al. Detection of ductal carcinoma in situ in women undergoing screening mammography. J Natl Cancer Inst 2002;94:1546–54.PubMedCrossRefGoogle Scholar
  31. 31.
    Welch HG, Black WC. Using autopsy series to estimate the disease “reservoir” for ductal carcinoma in situ of the breast. Ann Intern Med 1997;127:1023–8.PubMedGoogle Scholar
  32. 32.
    Barton MB, Moore S, Polk S, et al. Increased patient concern after false-positive mammograms. J Gen Intern Med 2001;16:150–6.PubMedCrossRefGoogle Scholar
  33. 33.
    Walter LC, Eng C, Covinsky KE. Screening mammography for frail older women: What are the burdens? J Gen Intern Med 2001;16:779–84.PubMedCrossRefGoogle Scholar
  34. 34.
    Fletcher SW, Elmore JG. Mammographic screening for breast cancer. N Engl J Med 2003;348:1672–80.PubMedCrossRefGoogle Scholar
  35. 35.
    Kimmick GG, Balducci L. Breast cancer and aging. Hematol Oncol Clin N Am 2000;14:213–33.CrossRefGoogle Scholar
  36. 36.
    Mandelblatt J, Saha S, Teutsch, et al. The cost-effectiveness of screening mammography beyond age 65 years: A systematic review for the U.S. Preventive Services Task Force. Ann Intern Med 2003;139:835–42.PubMedGoogle Scholar
  37. 37.
    Carney PA, Miglioretti DL, Yankaskas BC, et al. Individual and combined effects of age, breast density, and hormone replacement therapy use on the accuracy of screening mammography. Ann Intern Med 2003;138:168–75.PubMedGoogle Scholar
  38. 38.
    Oestreicher N, White E, Lehman CD, et al. Predictors of sensitivity of clinical breast examination (CBE). Breast Cancer Res Treat 2002;76:73–81.PubMedCrossRefGoogle Scholar
  39. 39.
    Satariano WA, Ragland DR. The effect of comorbidity on 3-year survival of women with primary breast cancer. Ann Intern Med 1994;120:104–10.PubMedGoogle Scholar
  40. 40.
    International Agency for Research on Cancer (IARC) Working Group on the Evaluation of Cervical Cancer Screening Programmes. Screening for squamous cervical cancer: Duration of low risk after negative results of cervical cytology and its implication for screening policies. Br Med J 1986;293:659–64.Google Scholar
  41. 41.
    Sawaya GF, Grady D, Kerlikowske K, et al. The positive predictive value of cervical smears in previously screened postmenopausal women: The Heart and Estrogen/Progestin Replacement Study (HERS). Ann Intern Med 2000;133:942–50.PubMedGoogle Scholar
  42. 42.
    Sirovich BE, Gottlieb DJ, Fisher ES. The burden of prevention: Downstream consequences of Pap smear testing in the elderly. J Med Screen 2003;10:189–95.PubMedCrossRefGoogle Scholar
  43. 43.
    Mandelblatt J, Lawrence W, Yi B, et al. The balance of harms, benefits, and costs of screening for cervical cancer in older women. Arch Intern Med 2004;164:245–7.PubMedCrossRefGoogle Scholar
  44. 44.
    Sawaya GF. Should routine screening Papanicolaou smears be done for women older than 65 years? Arch Intern Med 2004;164:243–5.PubMedCrossRefGoogle Scholar
  45. 45.
    Sawaya GF, Sung H, Kearney KA, et al. Advancing age and cervical cancer screening and prognosis. J Am Geriatr Soc 2001;49:1499–504.PubMedCrossRefGoogle Scholar
  46. 46.
    Ho CM, Chien TY, Huang SH, et al. Multivariate analysis of the prognostic factors and outcomes in early cervical cancer patients undergoing radical hysterectomy. Gynecol Oncol 2004;93:458–64.PubMedCrossRefGoogle Scholar
  47. 47.
    Nanda K, McCrory DC, Myers ER, et al. Accuracy of the Papanicolaou test in screening for and follow-up of cervical cytologic abnormalities: A systematic review. Ann Intern Med 2000;132:810–9.PubMedGoogle Scholar
  48. 48.
    Sawaya GF, Brown AD, Washington AE, et al. Current approaches to cervical-cancer screening. N Engl J Med 2001;344:1603–7.PubMedCrossRefGoogle Scholar
  49. 49.
    Thompson IM, Ankerst DP, Chi C, et al. Operating characteristics of prostate-specific antigen in men with an intial PSA level of 3.0 ng/ml or lower. J Am Med Assoc 2005;294:66–70.CrossRefGoogle Scholar
  50. 50.
    Harris R, Lohr KN. Screening for prostate cancer: An update of the evidence for the US Preventive Services Task Force. Ann Intern Med 2002;137:917–29.PubMedGoogle Scholar
  51. 51.
    Wilt TJ, MacDonald R, Rutks I, et al. Systematic review: Comparative effectiveness and harms of treatments for clinically localized prostate cancer. Ann Intern Med 2008;148:435–48.PubMedGoogle Scholar
  52. 52.
    McNaughton-Collins M, Fowler FJ, Caubet JF, et al. Psychological effects of a suspicious prostate cancer screening test followed by a benign biopsy result. Am J Med 2004;117:719–25.PubMedCrossRefGoogle Scholar
  53. 53.
    Albertsen PC. PSA testing: Public policy or private penchant? J Am Med Assoc 2006;296:2371–3.CrossRefGoogle Scholar
  54. 54.
    Bill-Axelson A, Holmberg L, Ruutu M, et al. Radical prostatectomy versus watchful waiting in early prostate cancer. N Engl J Med 2005;352:1977–84.PubMedCrossRefGoogle Scholar
  55. 55.
    Begg CB, Riedel ER, Bach PB, et al. Variations in morbidity after radical prostatectomy. N Engl J Med 2002;346:1138–44.Google Scholar
  56. 56.
    Porter MP, Stanford JL, Lange PH. The distribution of serum prostate-specific antigen levels among American men: Implications for prostate cancer prevalence and screening. Prostate 2006;66:1044–51.PubMedCrossRefGoogle Scholar
  57. 57.
    Coley CM, Barry MJ, Fleming C, Mulley AG. Clinical guideline part 1: Early detection of prostate cancer. Ann Intern Med 1997;126:394–406.PubMedGoogle Scholar
  58. 58.
    Sox HC. Screening for disease in older people. J Gen Intern Med 1998;13:424–5.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  1. 1.Associate Professor of Medicine, Division of GeriatricsUniversity of California, San Francisco, and the San Francisco Veterans Affairs Medical Center 181GSan FranciscoUSA

Personalised recommendations