Time to discourage cancer screening for people with limited life expectancies?

The USPSTF recommendations on the age to start breast cancer screening attracted a lot of attention and opposition. I support the idea of starting routine screening later, because I’m worried about the harms of screening –such as invasive and traumatic follow-up– that are generally not discussed. But of course it’s also hard to argue against the inevitable anecdotes of specific young people who were saved by early screening.

Screening of older people (or those ill with life-threatening conditions) is another matter, and I’m glad to see a BMJ article that recommends against breast or colorectal cancer screening for people who have a life expectancy of under 10 years. As MedPage Today reports (Oldest Patients May Not Need Cancer Screening):

The benefits of cancer screening come from early detection of asymptomatic cancers that would cause symptoms or death years later, according to the authors. As such, screening is associated with a “time lag to benefit.”

When life expectancy is shorter than the time lag, patients are exposed to immediate risks of screening, which has little chance of providing a benefit.

Maybe the USPSTF should have placed more emphasis on the older end of the spectrum rather than on the younger end. It might be easier for people to understand why an 80 year old with a serious illness might skip her mammogram due to the ratio of likely benefit to likely harm. With that example in mind it could be more straightforward to discuss benefits and harms in the younger cohort as well.

January 10, 2013

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