Cancer screening rates in individuals with different life expectancies

JAMA Intern Med. 2014 Oct;174(10):1558-65. doi: 10.1001/jamainternmed.2014.3895.


Importance: Routine cancer screening has unproven net benefit for patients with limited life expectancy.

Objective: To examine the patterns of prostate, breast, cervical, and colorectal cancer screening in the United States in individuals with different life expectancies.

Design, setting, and participants: Data from the population-based National Health Interview Survey (NHIS) from 2000 through 2010 were used and included 27 404 participants aged 65 years or older. Using a validated mortality index specific for NHIS, participants were grouped into those with low (<25%), intermediate (25%-49%), high (50%-74%), and very high (≥75%) risks of 9-year mortality.

Main outcomes and measures: Rates of prostate, breast, cervical, and colorectal cancer screening.

Results: In participants with very high mortality risk, 31% to 55% received recent cancer screening, with prostate cancer screening being most common (55%). For women who had a hysterectomy for benign reasons, 34% to 56% had a Papanicolaou test within the past 3 years. On multivariate analysis, very high vs low mortality risk was associated with less screening for prostate (odds ratio [OR], 0.65 [95% CI, 0.50-0.85]), breast (OR, 0.43 [95% CI, 0.35-0.53]), and cervical (OR, 0.50 [95% CI, 0.36-0.70]) cancers. There was less screening for prostate and cervical cancers in more recent years compared with 2000, and there was no significant interaction between calendar year and mortality risk for any cancer screening (P > .05 for all cancers). Our sensitivity analysis showed that screening was also common in individuals with less than 5-year life expectancy.

Conclusions and relevance: A substantial proportion of the US population with limited life expectancy received prostate, breast, cervical, and colorectal cancer screening that is unlikely to provide net benefit. These results suggest that overscreening is common in both men and women, which not only increases health care expenditure but can lead to net patient harm.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Biomarkers, Tumor / blood
  • Breast Neoplasms / prevention & control
  • Colonoscopy / statistics & numerical data
  • Colorectal Neoplasms / prevention & control
  • Early Detection of Cancer / methods
  • Early Detection of Cancer / statistics & numerical data*
  • Evidence-Based Medicine
  • Female
  • Humans
  • Life Expectancy*
  • Logistic Models
  • Male
  • Mammography / statistics & numerical data
  • Mass Screening / statistics & numerical data
  • Middle Aged
  • Neoplasms / mortality
  • Neoplasms / prevention & control*
  • Papanicolaou Test / statistics & numerical data
  • Prostate-Specific Antigen / blood
  • Prostatic Neoplasms / prevention & control
  • Risk
  • United States / epidemiology
  • Unnecessary Procedures / adverse effects
  • Unnecessary Procedures / economics
  • Unnecessary Procedures / statistics & numerical data*
  • Uterine Cervical Neoplasms / prevention & control


  • Biomarkers, Tumor
  • Prostate-Specific Antigen