Division of Geriatrics, Department of Medicine, University of California, San Francisco, USA.
Geriatrics, Palliative, and Extended Care Service Line, San Francisco Veterans Affairs Medical Center, 4150 Clement Street (181G), San Francisco, CA, 94121, USA.
Curr Oncol Rep. 2020 Aug 15;22(11):108. doi: 10.1007/s11912-020-00968-x.
We summarize the evidence of benefits, harms, and tools to assist in individualized decisions among older adults in screening for breast, prostate, colon, lung, and cervical cancer.
The benefits of cancer screening in older adults remain unclear due to minimal inclusion of adults > 75 years old in most randomized controlled trials. Indirect evidence suggests that the benefits of screening seen in younger adults (< 70 years old) can be extrapolated to older adults when they have an estimated life expectancy of at least 10 years. However, older adults, especially those with limited life expectancy, may be at increased risk for experiencing harms of screening, including overdiagnosis of clinically unimportant diseases, complications from diagnostic procedures, and distress after false positive test results. We provide a framework to integrate key factors such as health status, risks and benefits of specific tests, and patient preferences to guide clinicians in cancer screening decisions in older adults.
我们总结了在筛查乳腺癌、前列腺癌、结肠癌、肺癌和宫颈癌方面，为年龄较大的成年人提供个体化决策的获益、危害和工具的证据。
由于大多数随机对照试验很少纳入>75 岁的成年人，因此老年人癌症筛查的获益仍不清楚。间接证据表明，在估计预期寿命至少为 10 年的情况下，可将在较年轻成年人（<70 岁）中观察到的筛查获益外推至老年人群体。然而，老年人，尤其是预期寿命有限的老年人，可能面临更多的筛查危害，包括对临床不重要疾病的过度诊断、诊断程序的并发症以及假阳性检测结果后的困扰。我们提供了一个框架，以整合健康状况、特定检测的风险和获益以及患者偏好等关键因素，指导临床医生在老年人群体中进行癌症筛查决策。
