Forgo cancer screening? No thanks, say older Americans
March 17, 2013 | by Roberta Nichols
In recent years, older Americans have been advised to stop undergoing certain cancer screenings — such as Pap smears and prostate-specific antigen, or PSA, tests — because experts say they can lead to costly, risky and unnecessary medical procedures. What do senior citizens think of this advice? Not much.
At least that’s the perception of many of those interviewed for a study published March 11 in JAMA Internal Medicine. For that study, researchers questioned a small cross-section of older Americans to assess their views about medical screenings (and giving up those once-prescribed rituals). The findings were based on interviews with 33 adults between 63 and 91 years of age whose average age was 76.
“Despite the growing consensus that we need to curb overscreening, changing patient and physician behavior will be difficult in light of older adults’ highly favorable views of screening,” wrote lead author Alexia M. Torke, M.D., M.S., of the Indiana University Center for Aging Research.
“Messages about the benefits of cancer screening have been so effective that patients continue screening out of a moral obligation or even a custom,” continued Torke, who said that few of those interviewed had ever discussed screening cessation with their physicians. In fact, researchers found that doctors’ recommendations to stop getting screenings might even jeopardize their patients’ trust in them.
“Patients were skeptical and suspicious about the recommendations of experts and government panels to stop screening, expressing the concern, for example, that such recommendations were formulated to save money,” according to the article.
Interviewees were equally wary of statistics, researchers found. “A panel’s recommendation against screening may be based on complex statistics on estimated remaining life expectancy, risks, and rates of adverse effects, but our findings demonstrate the danger of assuming that patients will consider these statistical data helpful,” wrote Torke.
Given its statistically tiny sampling, the study affords more of a glimpse than a complete picture of how seniors view screening cessation, said Cy Stein, M.D., Ph.D., the Arthur and Rosalie Kaplan Chair and Professor of the Department of Medical Oncology and Therapeutics Research at City of Hope.
Yet the research does cast a light on the dilemma facing older patients, he said.
“It would be interesting to do this study in a larger way – to find out if this really is true,” said Stein, who was not involved in the research. “People who come up with these recommendations have to listen to what people are saying. It doesn’t make a lot of sense to say, ‘OK, everybody, let’s not get screened,’ when you don’t get the buy-in from people.”
Stein found one comment in the study particularly telling. “One person said, ‘I don’t believe in statistics.’ And they’re absolutely right because statistics don’t apply to any one individual. People make recommendations that the individuals are supposed to follow, but the numbers are only good for very large groups of people."
So what does any one individual do? “It’s not a black-and-white situation as it’s portrayed sometimes,” said Stein. “It’s heavily nuanced. I think people who say ‘don’t screen’ are not dealing with the perception of individuals as you see in this study – which is what the value of it is to me.”
As Stein said in an interview with Senior Planet.com: “I have to agree that mass screenings for PSA aren’t useful.”
“The problem is,” he continued in a Breakthroughs interview, “you don’t know if you’re the guy who needs it or not.”
“My position is biased,” said Stein. “I don’t see the 10,000 guys for whom the PSAs are worthless.” Instead he often sees patients with advanced prostate cancer, who never had the PSA test, which can predict levels of cancer in the blood. The test has been the source of controversy over the years, because it leads men to sometimes undergo needless surgery and radiation for cancers that are slow-growing and nonlethal.
“You cannot make blanket recommendations like, ‘If you’re over 75, don’t have it.’ You have to look at the whole person," Stein said. "There are 90-year-olds who have a reasonable chance of becoming 100.”
Stein advocates PSA tests for “anybody who wants it, particularly for all people with a family history of prostate cancer and for all African-Americans.” Each person must carefully consider their family medical history and their doctor’s recommendations.
“There’s a perception in the population that screening is a good thing to do,” Stein continued. “You’re never going to convince them with a statistical argument because people don’t grasp statistics.”
Except perhaps that they don’t want to become one.