Among a sample of adults aged 50 and older who had previously undergone screening for breast, colon or prostate cancer screening and had discussed screening with their providers or undergone testing within the past 2 years, we found that plans to stop screening were uncommon. A slightly higher proportion of respondents reported plans to stop breast cancer screening than prostate or colon cancer screening. A smaller proportion of respondents aged 70 years old and older reported plans to stop compared to those aged 50 to 69 years old. We also found that black respondents were less likely to report plans to stop screening than whites and that those of other races were more likely to have plans to stop than whites. When we examined aspects of discussions about cancer screening tests, we found that respondents who reported receiving information about stopping from providers or who did not participate in decision making about stopping were less likely to have plans to stop screening.
Our findings that a small proportion of people who have recently faced a decision about cancer screening report plans to stop cancer screening are consistent with other research in this area. One nationally representative survey found less than one-third of people surveyed reported that they would stop cancer screening 9
. However, the question was posed hypothetically to younger adults and therefore may not reflect older adults’ actual perceptions. Another smaller study, from two continuing care retirement communities, found similar results in adults aged 70 and over. This study adds to these findings in a larger sample of adults in the US who have either recently been screened for breast, colon or prostate cancer or had recent discussions with their health care providers.
Our analyses were notable because we did not find expected associations between those with poorer health status or increased age and plans to stop screening. It is important to note that our sampling strategy excluded those who had stopped cancer screening prior to our 2-year eligibility requirement. Therefore, among older individuals in poorer health, those who may be reticent to stop screening were more likely to be participants in our study. The decision process about stopping cancer screening is particularly relevant for these individuals because those who are older or in poorer health status are those most likely to experience net harm 8
. However, these negative results should be interpreted with caution given the small numbers, but suggest the need for further research about cancer screening in older adults with poorer health status.
As with respondent characteristics, we found few associations between aspects of discussions with providers and plans to stop screening. Our findings suggest that the provider input for people considering cancer screening, either by providing information or in the decision process, is inversely associated with plans to stop cancer screening. This suggests that providers’ attitudes toward stopping cancer screening and interactions between providers and patients could be an important target for future research.
Although our study does not address why a small proportion of respondents have plans to stop cancer screening, previous work suggests that people may be unaware of the delay in the benefit from screening and the need to consider life expectancy 10
. Given the new recommendations by the USPSTF, it will be important to understand how patients perceive the benefits and downsides of screening in the context of limited life expectancy and determine whether further education is needed. Resnick found that educating older adults about the risks and benefits of screening resulted in more realistic expectations about screening 21
. However, educating people about the complexities of screening may be challenging, as demonstrated by experience with prostate cancer screening 22–24
Our study has several limitations. First, our sample was limited to those who had recent contact with a health care provider and may bias our results in favor of screening. Although it is reassuring that our results are consistent with previous studies 9–11
, these studies may have similar biases. On the other hand, our intent was to estimate the proportion of people who have plans to stop screening in a population where the decision-making process was active, as this population would be a target to improve decision making. A different study design would be needed to estimate the proportion of the population who had already decided to stop cancer screening. Given the exclusion of those who may have already stopped, these results should not be construed to represent the overall stopping rate among the US population. Another limitation was that our survey questions have not been formally validated. However, we did perform cognitive interviews to help ensure if respondents were interpreting the questions in the manner we intended. Finally, the perceptions of the non-respondents may differ significantly from those reported here.
Plans to stop screening were uncommon among participants who had recently faced a screening decision. Further study is required to better understand how patients perceive the benefits and downsides of screening in the context of limited life expectancy. Given the recent US Preventive Services Task Force recommendations either against or limiting routine cancer screening for adults aged 75 and older, additional efforts to educate adults about the importance of considering the potential risks and benefits of screening may be warranted.