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Original Investigation |

Cancer Screening Rates in Individuals With Different Life Expectancies ONLINE FIRST

Trevor J. Royce, MD, MS1,2; Laura H. Hendrix, MS1; William A. Stokes, MD1,2; Ian M. Allen, MD, MPH1,2; Ronald C. Chen, MD, MPH1,3,4
[+] Author Affiliations
1Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill
2School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill
3Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill
4Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill
JAMA Intern Med. Published online August 18, 2014. doi:10.1001/jamainternmed.2014.3895
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Importance  Routine cancer screening has unproven net benefit for patients with limited life expectancy.

Objective  To examine the patterns of prostate, breast, cervical, and colorectal cancer screening in the United States in individuals with different life expectancies.

Design, Setting, and Participants  Data from the population-based National Health Interview Survey (NHIS) from 2000 through 2010 were used and included 27 404 participants aged 65 years or older. Using a validated mortality index specific for NHIS, participants were grouped into those with low (<25%), intermediate (25%-49%), high (50%-74%), and very high (≥75%) risks of 9-year mortality.

Main Outcomes and Measures  Rates of prostate, breast, cervical, and colorectal cancer screening.

Results  In participants with very high mortality risk, 31% to 55% received recent cancer screening, with prostate cancer screening being most common (55%). For women who had a hysterectomy for benign reasons, 34% to 56% had a Papanicolaou test within the past 3 years. On multivariate analysis, very high vs low mortality risk was associated with less screening for prostate (odds ratio [OR], 0.65 [95% CI, 0.50-0.85]), breast (OR, 0.43 [95% CI, 0.35-0.53]), and cervical (OR, 0.50 [95% CI, 0.36-0.70]) cancers. There was less screening for prostate and cervical cancers in more recent years compared with 2000, and there was no significant interaction between calendar year and mortality risk for any cancer screening (P > .05 for all cancers). Our sensitivity analysis showed that screening was also common in individuals with less than 5-year life expectancy.

Conclusions and Relevance  A substantial proportion of the US population with limited life expectancy received prostate, breast, cervical, and colorectal cancer screening that is unlikely to provide net benefit. These results suggest that overscreening is common in both men and women, which not only increases health care expenditure but can lead to net patient harm.

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Figure 1.
Screening Rates Stratified by 9-Year Mortality Risk

Percentages represent crude rates calculated using population-based sampling weights provided by National Health Interview Survey. Unweighted sample sizes: prostate cancer screening, n = 5701; breast cancer screening, n = 11 251; cervical cancer screening, n = 5024; colorectal cancer screening, n = 17 900.

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Place holder to copy figure label and caption
Figure 2.
Screening Rates Stratified by 5-Year Mortality Risk

Percentages represent crude rates calculated using population-based sampling weights provided by National Health Interview Survey. Unweighted sample sizes: prostate cancer screening, n = 5701; breast cancer screening, n = 11 251; cervical cancer screening, n = 5024; colorectal cancer screening, n = 17 900.

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