A new poll finds that 62% of people aged 50 to 80 don’t want guidelines for determining when to stop cancer screenings, such as mammograms and colonoscopies, to be based on life expectancy.
In all, 26% strongly disagreed with stopping the screening tests, and women were more likely to have a stronger stance against ceasing the tests. The poll, released Thursday, came from University of Michigan National Poll on Healthy Aging data. The survey operation was based at the U-M Institute for Healthcare Policy and Innovation and supported by AARP and Michigan Medicine, the University of Michigan’s academic medical center. The survey was conducted in January.
Guidelines that use life expectancy as a factor on when to screen — and not screen — also can play a role in what insurers have to cover.
The risks for some tests increase with age, which is why guidelines have used life expectancy for some screenings. A person needs to live about 10 years to get the full benefit of finding cancer early, some experts say. Of the respondents, 55% said that 10-year figure was about right, but 27% said it was too short.
Even older adults who want to avoid medical intervention unless necessary say life expectancy shouldn’t play a role in cancer screening guidelines. In fact, 57% of the people surveyed don’t agree with using projected life expectancy in cancer screening guidelines.
“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,” Brian Zikmund-Fisher, PhD, a healthcare decision-making researcher and professor from the U-M School of Public Health who assisted with the survey, said in a statement.
“But when it comes to a discussion between a healthcare provider and an individual patient, personalizing the cancer screening decision essentially means talking about how long that person is expected to live,” he added. “It also means sometimes deciding that not doing a screening is actually the healthiest approach.”
The poll comes at a time when a court decision could change insurance coverage for cancer screenings and tests in older adults.
“Right now, insurance plans must cover the cost of cancer screenings for people in the groups covered by guidelines set by the US Preventive Services Task Force,” Jeffrey Kullgren, MD, an associate professor of internal medicine at Michigan Medicine and physician and researcher at the VA Ann Arbor Healthcare System and the poll director, said in a statement. “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.”
Cancer screening standards can change if there’s new evidence about who gets the most benefit from them. For instance, a proposed USPSTF guideline lowers the age to start screening mammograms to 40, and there hasn’t been evidence to support screening women over 75.