ArticleJournal of the American Geriatrics Society2020
Clinician Perspectives on Overscreening for Cancer in Older Adults With Limited Life Expectancy.
Article in Journal of the American Geriatrics Society, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
16 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Factors Influencing Primary Care Practitioners' Cancer Screening Recommendations for Older Adults: a Systematic Review.Journal of general internal medicine · 2023Pooled it
- Patient-Reported Factors Associated With Older Adults' Cancer Screening Decision-making: A Systematic Review.JAMA network open · 2021Pooled it
- The effect of conflicting versus consistent messaging on older women's support for breast cancer screening cessation.Patient education and counseling · 2025Trial
- Tips from clinicians about if, when, and how to discuss life expectancy with older adults.Patient education and counseling · 2025Article
- Why do older adults stop cancer screening? Findings from the Medicare Current Beneficiary Survey.Journal of the American Geriatrics Society · 2025Article
- General practitioners' views and experiences of communicating with older people about cancer screening: a qualitative study.Family practice · 2024Article
- Non-use and inadequate use of cervical cancer screening among a representative sample of women in the United States.Frontiers in public health · 2024Article
- Clinician and patient perspectives on screening mammography among women age 75 and older: A pilot study of a novel decision aid.PEC innovation · 2023Article
- Perceived Barriers Among Clinicians and Older Adults Aged 65 and Older Regarding Use of Life Expectancy to Inform Cancer Screening: A Narrative Review and Comparison.Medical care research and review : MCRR · 2023Review
- Different Types of Patient Health Information Associated With Physician Decision-making Regarding Cancer Screening Cessation for Older Adults.JAMA network open · 2023Article
- Competing Causes of Death in Older Adults with Thyroid Cancer.Thyroid : official journal of the American Thyroid Association · 2021Article
- Primary care clinicians' perceptions of colorectal cancer screening tests for older adults.Preventive medicine reports · 2021Article
- Examining primary care physician rationale for not following geriatric choosing wisely recommendations.BMC family practice · 2021Article
- Cancer Prevention and Screening for Older Adults: Part 2. Interventions to Prevent and Screen for Breast, Prostate, Cervical, Ovarian, and Endometrial Cancer.Journal of the American Geriatrics Society · 2020Review
- Cancer Prevention and Screening for Older Adults: Part 1. Lung, Colorectal, Bladder, and Kidney Cancer.Journal of the American Geriatrics Society · 2020Review
- "It Can't Hurt!": Why Many Patients With Limited Life Expectancy Decide to Accept Lung Cancer Screening.Annals of family medicineArticle
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors.
Funding
Abstract
BACKGROUND/
objectivesGuidelines recommend against routine screening for breast, colorectal, and prostate cancers in older adults with less than 10 years of life expectancy. However, clinicians often continue to recommend cancer screening for these patients. We examined primary care clinicians' perspectives regarding overscreening, as defined by limited life expectancy.
designSemistructured, in-depth individual interviews.
settingTwenty-one academic and nonacademic primary care clinics in Maryland.
participantsThirty primary care clinicians from internal medicine, family medicine, medicine/pediatrics, and geriatric medicine. MEASUREMENTS: Interviews explored whether the clinicians believed that overscreening for breast, colorectal, or prostate cancers existed in older adults and their views on using life expectancy to decide on stopping routine screening. Audio recordings of the interviews were transcribed verbatim. Two investigators independently coded all transcripts using qualitative content analysis.
resultsMost clinicians were physicians (24/30) and women (16/30). Content analysis generated three major themes. (1) Many, but not all, clinicians perceived overscreening in older adults as a problem. (2) There was controversy around using limited life expectancy to define overscreening due to concerns that the guidelines did not capture potential nonmortality benefits of screening; that population-based screening data could not be easily applied to individuals; that this approach failed to account for patient choice; and that life expectancy predictions were inaccurate. (3) Some clinicians worried that using life expectancy to define overscreening may inadvertently introduce bias and lead to unintended harms.
conclusionsSeveral clinicians disagreed with guideline frameworks of using limited life expectancy to guide cancer screening cessation. Some disagreement stems from inadequate knowledge about the benefits and harms of cancer screening and indicates a need for education or decision support. Other reasons for disagreement highlight the need to refine the current recommended cancer screening approaches and identify strategies to avoid unintended consequences, such as introducing bias or exacerbating existing disparities. J Am Geriatr Soc 68:1462-1468, 2020.
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