Cancer screening among patients with advanced cancer Journal Article
| Authors: | Sima, C. S.; Panageas, K. S.; Schrag, D. |
| Article Title: | Cancer screening among patients with advanced cancer |
| Abstract: | Context: Cancer screening has been integrated into routine primary care but does not benefit patients with limited life expectancy. Objective: To evaluate the extent to which patients with advanced cancer continue to be screened for new cancers. Design, Setting, and Participants: Utilization of cancer screening procedures (mammography, Papanicolaou test, prostate-specific antigen [PSA], and lower gastrointestinal [GI] endoscopy) was assessed in 87 736 fee-for-service Medicare enrollees aged 65 years or older diagnosed with advanced lung, colorectal, pancreatic, gastroesophageal, or breast cancer between 1998 and 2005, and reported to one of the Surveillance, Epidemiology, and End Results (SEER) tumor registries. Participants were followed up until death or December 31, 2007, whichever came first. A group of 87 307 Medicare enrollees without cancer were individually matched by age, sex, race, and SEER registry to patients with cancer and observed over the same period to evaluate screening rates in context. Demographic and clinical characteristics associated with screening were also investigated. Main Outcome Measure: For each cancer screening test, utilization rates were defined as the percentage of patients who were screened following the diagnosis of an incurable cancer. Results: Among women following advanced cancer diagnosis compared with controls, at least 1 screening mammogram was received by 8.9% (95% confidence interval [CI], 8.6%-9.1%) vs 22.0% (95% CI, 21.7%-22.5%); Papanicolaou test screening was received by 5.8% (95% CI, 5.6%-6.1%) vs 12.5% (95% CI, 12.2%-12.8%). Among men following advanced cancer diagnosis compared with controls, PSA test was received by 15.0% (95% CI, 14.7%-15.3%) vs 27.2% (95% CI, 26.8%-27.6%). For all patients following advanced diagnosis compared with controls, lower GI endoscopy was received by 1.7% (95% CI, 1.6%-1.8%) vs 4.7% (95% CI, 4.6%-4.9%). Screening was more frequent among patients with a recent history of screening (16.2% [95% CI, 15.4%-16.9%] of these patients had mammography, 14.7% [95% CI, 13.7%-15.6%] had a Papanicolaou test, 23.3% [95% CI, 22.6%-24.0%] had a PSA test, and 6.1% [95% CI, 5.2%-7.0%] had lower GI endoscopy). Conclusion: A sizeable proportion of patients with advanced cancer continue to undergo cancer screening tests that do not have a meaningful likelihood of providing benefit. ©2010 American Medical Association. All rights reserved. |
| Keywords: | controlled study; aged; aged, 80 and over; major clinical study; case-control studies; advanced cancer; united states; pancreas cancer; cancer staging; neoplasms; colorectal cancer; prostate specific antigen; demography; diagnostic procedure; breast cancer; cancer screening; lung cancer; mass screening; prostate-specific antigen; health care utilization; medicare; mammography; colonoscopy; control group; seer program; neoplasms, second primary; screening test; esophagus cancer; gastrointestinal endoscopy; cost-benefit analysis; sigmoidoscopy; vaginal smears; endoscopy, gastrointestinal; unnecessary procedures; papanicolaou test |
| Journal Title: | JAMA - Journal of the American Medical Association |
| Volume: | 304 |
| Issue: | 14 |
| ISSN: | 0098-7484 |
| Publisher: | American Medical Association |
| Date Published: | 2010-10-13 |
| Start Page: | 1584 |
| End Page: | 1591 |
| Language: | English |
| DOI: | 10.1001/jama.2010.1449 |
| PUBMED: | 20940384 |
| PROVIDER: | scopus |
| PMCID: | PMC3728828 |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 1" - "Export Date: 20 April 2011" - "CODEN: JAMAA" - "Source: Scopus" |
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