Cancer Prevention and Screening for Older Adults

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Journal of the American Geriatrics Society Research Summary

Improved cancer screening and treatment, along with much lower rates of tobacco use, have led to a decrease in cancer diagnoses and deaths. However, because the risk for many cancers increases as people age, it is still the second most common cause of death in older adults after heart disease.

Cancer prevention is important for older adults in order to reduce deaths and prevent the poor quality of life that can be caused by advanced cancer and treatment side effects. Efforts focus on preventing cancer as well as identifying the disease in its early stages by using screening tests. When someone is diagnosed with an early-stage cancer, they are likely to require less extensive treatment and have a better chance for recovery.

Recently, a research team offered new information and guidance for healthcare providers about cancer screening and prevention for older adults. They published their guidance in the Journal of the American Geriatrics Society. According to the researchers, healthcare practitioners need to fully understand how a particular cancer will impact an older adult. They also need to consider the effectiveness, drawbacks, and expense of cancer prevention and screening. Finally, health care practitioners need to understand how well a person will fare—with and without cancer treatment—when they discuss cancer screening with older adults.

Many cancers occur only after long-term exposure to cancer risk factors. Some cancers grow slowly and only become a problem years after they first occur. For older adults with a limited life expectancy, a late-life cancer may not become a problem before they die. The term “over-screening” is applied to identifying such cancers.

Though many screening tests do not involve invasive procedures, they are still not risk-free. For one thing, people can experience anxiety regarding test results. If a cancer is suspected, older adults could face unnecessary diagnostic surgery (a procedure that is used to confirm a diagnosis or to retrieve a tissue sample) and its complications.

Recommendations for when to stop cancer screenings in older adults have up to now been based on age. But over the past ten years or so, guidelines increasingly use life expectancy to inform screening decisions. Age, other chronic conditions an older adult may have, and their physical and cognitive function have a significant impact on life expectancy.

Your healthcare provider can use several simple tools to help determine your life expectancy.

When making decisions about screening tests, your provider should consider your ability to tolerate and benefit from cancer treatment if cancer is detected.

Experts are beginning to understand that age is not the primary deciding factor in a person’s ability to tolerate or benefit from cancer treatment. However, frail older adults who have multiple chronic conditions, difficulty maintaining independence, and illnesses that are more common with increasing age are at higher risk for poor outcomes, treatment-related side-effects, or death. A geriatric assessment or other frailty assessment tools can help identify older adults who are more likely to tolerate and benefit from cancer treatment.

Many older adults are more concerned about their quality of life than their quantity of life. When they discuss the potential benefits and harms of screening for or treating cancer, they may decide against having the intervention.

The researchers concluded that healthcare providers should educate their patients about their cancer risks, and when appropriate, recommend interventions to both prevent and screen for cancer. An older adult’s life expectancy is a better deciding factor than age to determine when to stop cancer screenings. Finally, healthcare providers should avoid recommending treatments that are not proven to benefit older adults.

This summary is from “Cancer Prevention and Screening for Older Adults: Part One. Lung, Colorectal, Bladder and Kidney Cancer.” It appears online ahead of print in the Journal of the American Geriatrics Society. The study authors are Patrick P. Coll, MD, AGSF, CMD; Beatriz Korc-Grodzicki, MD, PhD, AGSF; Benjamin T. Ristau, MD, MHA; Armin Shahrokni, MD, MPH; Alexander Koshy, MD; Olga T. Filippova MD, MSc; and Imran Ali MD, MS, MPH.

 

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