Screening for cancer beyond recommended upper age limits: views and experiences of older people

Jenna Smith; Rachael H Dodd; Vasi Naganathan; Erin Cvejic; Jesse Jansen; Katharine Wallis; Kirsten J McCaffery

doi:10.1093/ageing/afad196

Screening for cancer beyond recommended upper age limits: views and experiences of older people

Age Ageing. 2023 Oct 2;52(10):afad196. doi: 10.1093/ageing/afad196.

Authors

Jenna Smith^{1

2}, Rachael H Dodd^{1

2

3}, Vasi Naganathan^{4

5}, Erin Cvejic², Jesse Jansen^{1

2

6}, Katharine Wallis⁷, Kirsten J McCaffery^{1

2}

Affiliations

¹ Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
² Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
³ The Daffodil Centre, The University of Sydney, Sydney, NSW, Australia.
⁴ Centre for Education and Research on Ageing, Department of Geriatric Medicine, Concord Repatriation Hospital, Sydney, NSW, Australia.
⁵ Concord Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
⁶ School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
⁷ General Practice Clinical Unit, The University of Queensland, Queensland, QLD, Australia.

PMID: 37930739
DOI: 10.1093/ageing/afad196

Abstract

Background: Internationally, screening programmes and clinical practice guidelines recommend when older adults should stop cancer screening using upper age limits, but it is unknown how older adults view these recommendations.

Objective: To examine older adults' views and experiences about continuing or stopping cancer screening beyond the recommended upper age limit for breast, cervical, prostate and bowel cancer.

Design: Qualitative, semi-structured interviews.

Setting: Australia, telephone.

Subjects: A total of 29 community-dwelling older adults (≥70-years); recruited from organisation newsletters, mailing lists and Facebook advertisements.

Methods: Interviews were audio-recorded, transcribed and analysed thematically using Framework Analysis.

Results: Firstly, older adults were on a spectrum between trusting recommendations and actively deciding about cancer screening, with some who were uncertain. Secondly, participants reported limited in-depth discussions with health professionals about cancer screening. In primary care, discussions were focused on checking they were up to date with screening or going over results. Discussions mostly only occurred if older adults initiated themselves. Finally, participants had a socially- and self-constructed understanding of screening recommendations and potential outcomes. Perceived reasons for upper age limits were cost, reduced cancer risk or ageism. Risks of screening were understood in relation to their own social experiences (e.g. shared stories about friends with adverse outcomes of cancer treatment or conversations with friends/family about controversy around prostate screening).

Conclusions: Direct-to-patient information and clinician support may help improve communication about the changing benefit to harm ratio of cancer screening with increasing age and increase understanding about the rationale for an upper age limit for cancer screening programmes.

Keywords: cancer screening; communication; decision-making; informed choice; older people; overdiagnosis; qualitative research.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Ageism*
Australia
Communication
Early Detection of Cancer
Humans
Male
Neoplasms* / diagnosis