Cancer screening among patients with advanced cancer.

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.

[1]  E. Feuer,et al.  Modeling the dissemination of mammography in the United States , 2005, Cancer Causes & Control.

[2]  Amy B. Knudsen,et al.  Evaluating Test Strategies for Colorectal Cancer Screening: A Decision Analysis for the U.S. Preventive Services Task Force , 2008, Annals of Internal Medicine.

[3]  Cristián Zegers Ariztía,et al.  Manual , 2002 .

[4]  R. Groman,et al.  Racial and ethnic disparities in health care: a position paper of the American College of Physicians. , 2004, Annals of internal medicine.

[5]  A. Jemal,et al.  Annual report to the nation on the status of cancer, 1975‐2006, featuring colorectal cancer trends and impact of interventions (risk factors, screening, and treatment) to reduce future rates , 2010, Cancer.

[6]  K. Kupka,et al.  International classification of diseases: ninth revision. , 1978, WHO chronicle.

[7]  M. Winston Physician Quality Reporting Initiative (PQRI) , 2011 .

[8]  B. Gordon Current procedural terminology , 1966 .

[9]  J. Iglehart Finding money for health care reform--rooting out waste, fraud, and abuse. , 2009, The New England journal of medicine.

[10]  R. Truog Screening mammography and the "r" word. , 2009, The New England journal of medicine.

[11]  Peter C Gøtzsche,et al.  Overdiagnosis in publicly organised mammography screening programmes: systematic review of incidence trends , 2009, BMJ : British Medical Journal.

[12]  C. Compton,et al.  AJCC Cancer Staging Manual , 2002, Springer New York.

[13]  W. Odling-Smee,et al.  Screening for Breast Cancer , 1985, The Lancet.

[14]  D. Berry,et al.  Effect of screening and adjuvant therapy on mortality from breast cancer , 2005 .

[15]  H. Welch Overdiagnosis and mammography screening , 2009, BMJ : British Medical Journal.

[16]  Sankey V. Williams,et al.  Screening Mammography in Women 40 to 49 Years of Age: A Systematic Review for the American College of Physicians , 2007, Annals of Internal Medicine.

[17]  A. Jerant,et al.  Determinants of racial/ethnic colorectal cancer screening disparities. , 2008, Archives of internal medicine.

[18]  I. Nyirjesy Enthusiasm for Cancer Screening in the United States , 2008 .

[19]  P. Walsh,et al.  Overdiagnosis due to prostate-specific antigen screening: lessons from U.S. prostate cancer incidence trends. , 2003, The Journal of urology.

[20]  Laura Esserman,et al.  Rethinking screening for breast cancer and prostate cancer. , 2009, JAMA.

[21]  L. Walter,et al.  Cancer screening in elderly patients: a framework for individualized decision making. , 2001, JAMA.

[22]  T. Raven Death by denial , 1995, The Lancet.

[23]  A. Back,et al.  Dealing with conflict in caring for the seriously ill: "it was just out of the question". , 2005, JAMA.

[24]  K. Kahn,et al.  Physician factors associated with discussions about end‐of‐life care , 2010, Cancer.

[25]  L. Berlin Should I Be Tested for Cancer? Maybe Not and Here's Why , 2004 .

[26]  H M Rosenberg,et al.  Annual report to the nation on the status of cancer (1973 through 1998), featuring cancers with recent increasing trends. , 2001, Journal of the National Cancer Institute.

[27]  E. Winer,et al.  On mammography--more agreement than disagreement. , 2009, The New England journal of medicine.

[28]  Nancy Breen,et al.  Progress in cancer screening practices in the United States , 2003, Cancer.

[29]  L. Schwartz,et al.  The benefits and harms of mammography screening: understanding the trade-offs. , 2010, JAMA.

[30]  Deborah Schrag,et al.  Overview of the SEER-Medicare Data: Content, Research Applications, and Generalizability to the United States Elderly Population , 2002, Medical care.

[31]  Deborah Schrag,et al.  Primary care physicians who treat blacks and whites. , 2004, The New England journal of medicine.

[32]  A. Bothe,et al.  Current Procedural Terminology: changes for 2007. , 2007, Bulletin of the American College of Surgeons.

[33]  H. Welch,et al.  Cervical cancer screening among women without a cervix. , 2004, JAMA.