Abstract
INTRODUCTION AND OBJECTIVES: Given that the harms of prostate (PCa) and breast (BCa) cancer screening may outweigh the benefits for individuals with limited life expectancy, current guidelines do not recommend screening in these individuals. However, there is limited nationwide data addressing the prevalence of nonrecommended screening for PCa and BCa. The objective of this study is to estimate the US nationwide, and state-by-state prevalence of non-recommended PCa and BCa screening in individuals with a life expectancy<10 years. METHODS: A cohort of 150,452 individuals aged 65 years (weighted population size of 43.857 million) who responded to the 2012 Behavioral Risk Factor Surveillance System survey. Published life tables relying on age, sex, race, and comorbidity were used to calculate life expectancy. The main outcome measure is self-reported prostate specific antigen (PSA) test (without history of prostate cancer/problems) or mammogram within the past year. RESULTS: Overall, 16.3% of individuals aged 65 and older underwent non-recommended PSA or mammography screening (based on a life expectancy of <10 years). This represents 32.1% of the individuals aged 65 and older who were screened. At adjusted analysis, the prevalence of non-recommended screening was higher in older (OR: 1.11; 95%CI: 1.10-1.11), and in Black (OR: 1.27, 95%CI: 1.111.46) individuals. Conversely, it was lower in females (OR: 0.63; 95%CI: 0.59-0.67). Likewise, individuals without access to a health care provider (0.43; 95%CI: 0.36-0.51) or who lacked health insurance (OR: 0.47; 95%CI: 0.36-0.61) were less likely to receive non-recommended screening. Significant state-by-state variation in non-recommended screening was observed, especially for PCa. CONCLUSIONS: Non-recommended screening is reported in nearly one out of three screened individuals aged 65 years, and varies significantly by state. The prevalence of non-recommended screening is higher for PCa than for BCa screening (higher in male than females). Policy should be directed to incentivize appropriate use of screening tests, which could lead to more cost-efficient utilization of health care resources.
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