Many patients with advanced cancers and a poor prognosis receive routine screenings—mammograms, Pap smears, prostate-specific antigen (PSA) tests—for other cancers even though there is little likelihood of these tests to provide benefit, according to a new study released in the October issue of JAMA.
For the study, Sima and colleagues investigated screening rates among Medicare enrollees aged 65 years and older diagnosed with advanced lung, colorectal, pancreatic, gastroesophageal, or breast cancer. Using the SEER tumor registry 87,736 patients were identified for the years 1998 through 2005 and followed until 2007 or death. A group of 87,307 matched controls were also identified from Medicare enrollees.
Among women with advanced cancer, 8.9% received at least one screening mammogram and 5.8% underwent a Pap test compared with 22% and 12.5%, respectively, of controls. Among men with advanced cancer, 15% underwent PSA tests compared with 27.2% of controls. Only gastrointestinal endoscopy was performed less frequently for those with advanced cancer: 1.7% for those with advanced cancer compared with 4.7% for controls.
The researchers noted that, in today’s legislative and economic environments, “identification of episodes of unnecessary care and strategies to curb them has the potential to be a win-win for patients, health care practitioners, and the public.”