Get Healthy!

• Posted September 29, 2023

Most Older Americans Object to Cancer Screening Cutoffs Based on Life Expectancy: Poll

While guidelines for cancer screening have begun factoring in life expectancy, a new poll shows a majority of older adults disagree with age cutoffs based on how long a person is expected to live.

The University of Michigan National Poll on Healthy Aging queried more than 2,500 adults aged 50 to 80 by phone and online in January 2023.

The poll found that 62% of people in this age group thought that national guidelines for stopping cancer screenings in individual patients should not be based on how long that person might have left to live.

“Personalizing cancer screening decisions to each patient's health situation, rather than using one-size-fits-all age cutoffs, could benefit both very healthy and less healthy patients in different ways,” said study author Brian Zikmund-Fisher, a health care decision-making researcher and professor from University of Michigan's School of Public Health, in Ann Arbor.

“But when it comes to a discussion between a health care provider and an individual patient, personalizing the cancer screening decision essentially means talking about how long that person is expected to live," he added in a Michigan Medicine news release. “It also means sometimes deciding that not doing a screening is actually the healthiest approach.”

Guidelines have started factoring in life expectancy because the risks from some screening tests increase with age, according to the pollsters. Studies also show that a person needs to live about 10 years to get the full benefit of finding cancer early.

Yet even among adults who the poll staff might consider “medical minimizers,” avoiding medical intervention unless necessary, 57% disagreed with the idea of using life expectancy for cancer screening guidelines.

About 70% of adults polled thought it was fine for older adults to get screenings that aren't recommended.

About 55% of those polled said the 10-year life expectancy limit was about right, but 27% said it was too short.

Guidelines play a role in helping doctors decide which screening to do, but they also affect insurance coverage.

Coverage is currently in flux because of a federal court case that could lead to the end of required insurance coverage for cancer screenings and other preventive care based on national guidelines, the poll authors noted.

“Right now, insurance plans must cover the cost of cancer screenings for people in the groups covered by guidelines set by the U.S. Preventive Services Task Force [USPSTF],” explained poll director Dr. Jeffrey Kullgren. He is an associate professor of internal medicine at Michigan Medicine and physician and researcher at the VA Ann Arbor Healthcare System.

“Depending on how the courts eventually rule, insurance coverage of some cancer screenings could end for some older adults, because insurers would be allowed to set their own standards for coverage and not have to abide by guidelines,” Kullgren added.

Cancer screening guidelines also change with new evidence about who gets the most benefit from them. A draft USPSTF guideline that may take effect soon lowers the age for the start of screening mammograms to 40 but continues to not support screening women over age 75.

Digging further into people's feelings about using life expectancy in screening recommendations, 26% said they strongly disagreed with this, including more women than men.

Strong disagreement about stopping screening based on life expectancy was higher among Black respondents (at 37%) compared to Hispanic participants (at 28%) or white people (at 24%).

The poll results also found that among “medical minimizers,” 57% disagreed with using life expectancy in cancer screening guidelines, compared to 73% of “medical maximizers.”

More information

The U.S. National Cancer Institute has more on cancer screening.

SOURCE: Michigan Medicine, news release, Sept. 27, 2023