Capsule Commentary on Goodwin et al., Receipt of Cancer Screening is a Predictor of Life Expectancy
J Gen Intern Med
Capsule Commentary on Goodwin et al., Receipt of Cancer Screening is a Predictor of Life Expectancy
Mara A. Schonberg 0 1
0 Compliance with Ethical Standards:
1 Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center , Brookline, MA , USA
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C tancy is increasingly being recognized as low-value
ancer screening among adults with <10 year life
expeccare.1 Therefore, policy makers are interested in developing
algorithms to identify and avoid low-value use of cancer
screening among older adults. To identify older adults who
receive low-value cancer screening, it is necessary to
accurately estimate their life expectancy. Therefore, a previous
study using Medicare claims data created and validated an
algorithm to estimate beneficiary life expectancy based on
beneficiary age, sex, and the presence of comorbidities.2
Ideally, this algorithm could now be used to help health systems
identify low-value cancer screening among their older
patients. However, Goodwin et al.3 in this manuscript identified
an important limitation of using claims-based estimates of life
expectancy.
Using data from a 5 % sample of Medicare beneficiaries,
aged 69–90 years by the end of 2002 (543,970 women and
362,753 men), Goodwin et al. examined the association of the
receipt of screening mammography (in 2001/2002) or PSA (in
2002) on beneficiaries’ overall survival through 2012. They
found that women who underwent screening mammography
lived around 2 years longer than women that did not get
screened and men that received PSA screened lived around
1 year longer than those who were not screened. Of note,
excluding beneficiaries diagnosed with cancer as a result of
these tests did not affect the overall findings. However, since
claims data do not capture beneficiaries’ function, cognition,
disease severity, or social support, and these factors affect
receipt of cancer screening4, the prolonged survival associated
with receipt of cancer screening among older adults is likely
explained by these factors and probably reflects that providers
are screening based on their judgement about patient’s life
expectancy.
Based on this study, it is important for policy makers to
realize that claims-based estimates of life expectancy likely
underestimate life expectancy among older adults receiving
cancer screening. Therefore, using these measures could
overestimate overuse of these tests. To overcome this limitation,
policy makers could consider using shorter life expectancy
estimates (e.g., 7 rather than 10 years) to identify low-value
receipt of cancer screening among older adults.
Conflict of Interest: The author has no conflicts of interest with this
article.
1. Wilt TJ , Harris RP , Qaseem A . Screening for cancer: advice for high-value care from the American College of Physicians . Ann Intern Med . 2015 ; 162 ( 10 ): 718 - 725 .
2. Tan A , Kuo YF , Goodwin JS . Predicting life expectancy for communitydwelling older adults from Medicare claims data . Am J Epidemiol . 2013 ; 178 ( 6 ): 974 - 983 .
3. Goodwin JS , Sheffield K , Li S , Tan A . Receipt of cancer screening is a predictor of life expectancy . J Gen Intern Med . doi: 10 .1007/s11606-016- 3787-y.
4. Schonberg MA , Breslau ES , McCarthy EP . Targeting of mammography screening according to life expectancy in women aged 75 and older . J Am Geriatr Soc . 2013 . (...truncated)