Target cancer screening at healthier people

Louise Prime

Friday, 11 January 2013

Cancer screening in people whose life expectancy is fairly short anyway is likely to bring more harm than benefit, researchers have confirmed. In their study, published on bmj.com, they conclude that screening for breast and colorectal cancer should be targeted at people with a life expectancy of about 10 years or more ? but they are at pains to point out that their results should not be used to deny screening to people likely to live for less time than that.

The authors set out to find how long it takes for the benefits of cancer screening for an individual patient to outweigh the risks, such as worry, false positives, possibly unnecessary treatment and complications. Using data from four studies on colorectal cancer screening and five on breast cancer screening, in people older than 50, conducted in the UK, US, Sweden and Denmark, they estimated the ?time-lag to benefit? of screening.

Five years after screening, a mean of 2.8 deaths from colorectal cancer were prevented for every 10,000 people screened, but by 15 years 23 deaths would have been prevented.

For breast cancer, at five years 5.1 deaths would be prevented for every 10,000 people screened, rising to 19 deaths prevented by 15 years.

The study authors point out that because about one in ten people screened have a false positive result, and many have possibly unnecessary treatment, screening might not be advisable in those with shorter life expectancy.

They suggest: ?For most patients with a life expectancy greater than ten years the benefits [of colorectal cancer screening] likely outweigh the harms ? [and] for most women with a life expectancy greater than 10 years the benefits [of breast cancer screening] outweigh the harms,? and that these people should be encouraged to undergo screening. They add that people with a life expectancy of 3-5 years ?probably should be discouraged from screening since the potential risks likely outweigh the very small probability of benefit?.

They conclude: ?Incorporating time lag estimates into screening guidelines would encourage a more explicit consideration of the risks and benefits of screening for breast and colorectal cancer. This would probably result in a more individualised process of decision making for the heterogeneous population of older adults.?

Source: http://www.onmedica.com/newsArticle.aspx?id=03e82032-d3f5-4b47-b536-cdc94b29ea71

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