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Invited Commentary
April 8, 2013

Talking About Stopping Cancer Screening—Not So Easy
Comment on “Older Adults and Forgoing Cancer Screening: ‘I Think It Would be Strange’”

Author Affiliations

Author Affiliations: Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr Schonberg); and Division of Geriatrics, University of California, San Francisco, and San Francisco VA Medical Center (Dr Walter).

JAMA Intern Med. 2013;173(7):532-533. doi:10.1001/jamainternmed.2013.3233

As the population ages, increasingly older adults are screened for cancer, including those with short life expectancies. The benefit of cancer screening is finding cancer early before it spreads and requires aggressive therapy and/or leads to loss of life. Because some older adults may not live long enough for a screen-detectable cancer to become clinically significant, the benefits of screening in older adults, particularly those in poor health, are not established. Meanwhile, harms of cancer screening are immediate and include pain and anxiety related to the screening test, complications of the screening test (eg, bowel perforation from colonoscopy) or additional tests after a false-positive result, and overdiagnosis (finding tumors that would never cause symptoms in an older adult's lifetime). Overdiagnosis is particularly concerning because some older adults experience significant complications from cancer treatment. Given potential harms and uncertain benefits, it is important to understand how older adults decide on cancer screening.

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