Discontinuing Cancer Screening for Older Adults: a Comparison of Clinician Decision-Making for Breast, Colorectal, and Prostate Cancer Screenings

For older patients (65+) with limited life expectancies (<10 yrs), cancer screening may provide little to no benefit while also posing significant risks and burdens. Many of these patients continue to undergo routine screening despite guidelines to the contrary. Primary care clinicians must manage multiple preventative care decisions for patients in this situation, and guidelines often differ in their approaches. This qualitative study from the US aimed to compare and contrast primary care clinicians’ decision-making, communication, and interaction with specialists across breast, prostate, and colorectal cancer screenings when caring for older adults with limited life expectancies. The results highlighted 4 major themes: 1) clinicians more often continued to screen patients for breast and prostate cancers beyond the age recommended by guidelines than they did for colorectal cancer (CRC);  2) clinician priorities differed when assessing the benefits/harms of each screening – e.g. some continued screening for CRC because the test has high efficacy where others were more likely to stop CRC screening due to high risks associated with the screening procedure, and some continued screening for prostate cancer because of the poor outcomes associated with advanced disease where others stopped screening due to high false positive rates and harms associated with downstream tests; 3) clinicians more readily discussed the harms associated with CRC and prostate cancer screening than for breast cancer; and 4) gastroenterologists were perceived as more involved in colonoscopy decisions than specialists for breast and prostate cancer screening. These results highlight the need for more explicit guidance for primary care clinicians on how to weigh competing considerations in cancer screening . Read full text