Annals of Internal Medicine

Summaries for Patients

Personalizing Age of Cancer Screening Cessation

The full report is titled

Personalizing Age of Cancer
Screening Cessation Based on
Comorbid Conditions: Model
Estimates of Harms and Benefits.
It is in the 15 July 2014 issue of
Annals of Internal Medicine
(volume 161, pages 104-112).
The authors are
I. Lansdorp-Vogelaar, R. Gulati,
A.B. Mariotto, C.B. Schechter,
T.M. de Carvalho, A.B. Knudsen,
N.T. van Ravesteyn,
E.A.M. Heijnsdijk, C. Pabiniak,
M. van Ballegooijen,
C.M. Rutter, K.M. Kuntz,
E.J. Feuer, R. Etzioni,
H.J. de Koning, A.G. Zauber,
and J.S. Mandelblatt.

What is the problem and what is known about it so far?

Cancer rates increase with age, and cancer screening can help find some cancer early, when
it is more curable. The decision about whether to screen for cancer is based on the tradeoff
between benefits (such as years of life gained) and harms (such as false-positive test results
when cancer is not present and the diagnosis of cancer that grows so slowly that it would
never cause problems if left undetected). Less is known about how the presence of different
illnesses affects this tradeoff in older people. Current guidelines for cancer screening do not
include information about whether to screen older people who have other illnesses.
Why did the researchers do this particular study?
To estimate the benefits and harms of screening older persons for 3 types of cancer (breast,
prostate, and colorectal) by different ages and with different illnesses to help inform
decisions about at what ages cancer screening can be stopped.
Who was studied?
One of the most influential groups to issue guidelines about cancer screening has
recommended that people who have had regular screening tests can stop screening for
breast cancer and colorectal cancer after age 74 years. Therefore, the investigators studied
people around this age.
How was the study done?
The investigators created models with computer software that calculated the probable
outcomes when mammography was used to screen for breast cancer, blood tests were used
to screen for prostate cancer, and tests that look for blood in stool specimens were used to
screen for colorectal cancer.
What did the researchers find?
For all 3 cancer sites (breast, prostate, and colorectal), the tradeoff between benefits and
harms was roughly the same in people those aged 74 years with average health as it was in
people aged 76 years with no illnesses, those aged 74 years with mild illness, those aged 72
years with moderately severe illness, and those aged 66 years with severe illness.
What were the limitations of the study?
The conclusions are for large populations of older people, and the results could be
different for each person. Decisions about when to stop screening for cancer should
be discussed with providers.
What are the implications of the study?
The presence of other illnesses should be included in discussions about when to stop
screening older people for cancer.

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I-22 2014 American College of Physicians

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