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01-04-2022 | Prostate Cancer | Original Research: Qualitative Research

Discontinuing Cancer Screening for Older Adults: a Comparison of Clinician Decision-Making for Breast, Colorectal, and Prostate Cancer Screenings

Authors: Justine P. Enns, BSc, Craig E. Pollack, MD, MHS, Cynthia M. Boyd, MD, MPH, Jacqueline Massare, BS, Nancy L. Schoenborn, MD, MHS

Published in: Journal of General Internal Medicine | Issue 5/2022

Abstract

Background

While guidelines recommend against routine screening for breast, prostate, and colorectal cancers in older adults (65+ years) with <10-year life expectancy, many of these patients continue to be screened. How clinicians consider screening cessation across multiple cancer screening types is unknown.

Objective

To compare and contrast clinicians’ perspectives on discontinuing breast, prostate, and colorectal cancer screenings in older adults.

Design

Qualitative, semi-structured interviews.

Participants

Primary care clinicians in Maryland (N=30)

Approach

We conducted semi-structured interviews with individual clinicians. Interviews were recorded, transcribed, and analyzed using standard techniques of qualitative content analysis to identify major themes.

Key Results

Participants were mostly physicians (24/30) and women (16/30). Four major themes highlighted differences in decision-making across cancer screenings: (1) Clinicians reported more often screening beyond guideline-recommended ages for breast and prostate cancers than colorectal cancer; (2) clinicians had different priorities when considering the benefits/harms of each screening; for example, some prioritized continuing colorectal cancer screening due to the test’s high efficacy while others prioritized stopping colorectal cancer screening due to high procedural risk; some prioritized continuing prostate cancer screening due to poor outcomes from advanced prostate cancer while others prioritized stopping prostate cancer screening due to high false positive test rates and harms from downstream tests; (3) clinicians discussed harms of prostate and colorectal cancer screening more readily than for breast cancer screening; (4) clinicians perceived more involvement with gastroenterologists in colonoscopy decisions and less involvement from specialists for prostate and breast cancer screening.

Conclusions

Our results highlight the need for more explicit guidance on how to weigh competing considerations in cancer screening (such as test accuracy versus ease of cancer treatment after detection). Recognizing the complexity of the benefit/harms analysis as clinicians consider multiple cancer screenings, future decision support tools, and clinician education materials can specifically address the competing considerations.

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Title: Discontinuing Cancer Screening for Older Adults: a Comparison of Clinician Decision-Making for Breast, Colorectal, and Prostate Cancer Screenings
Authors: Justine P. Enns, BSc
Craig E. Pollack, MD, MHS
Cynthia M. Boyd, MD, MPH
Jacqueline Massare, BS
Nancy L. Schoenborn, MD, MHS
Publication date: 01-04-2022
Publisher: Springer International Publishing
Keywords: Prostate Cancer
Mammography
Prostate Cancer
Colonoscopy
Mammography
Colorectal Cancer
Colorectal Cancer
Published in: Journal of General Internal Medicine / Issue 5/2022
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-021-07121-9

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