Influence of Age, Health, and Function on Cancer Screening in Older Adults with Limited Life Expectancy

Background/Objectives: We examined the relationship between cancer screening and life expectancy predictors, focusing on the influence of age versus health and function, in older adults with limited life expectancy. Design: Longitudinal cohort study Setting: National Health and Aging Trends Study (NHATS) with linked Medicare claims. Participants: Three cohorts of adults 65+ enrolled in fee-for-service Medicare were constructed: women eligible for breast cancer screening (n = 2043); men eligible for prostate cancer screening (n = 1287); men and women eligible for colorectal cancer screening (n = 3759). Measurements: We assessed 10-year mortality risk using 2011 NHATS data, then used claims data to assess 2-year prostate and breast cancer screening rates and 3-year colorectal cancer screening rates. Among those with limited life expectancy (10-year mortality risk > 50%), we stratified participants at each level of predicted mortality risk and split participants in each risk stratum by the median age. We assembled two sub-groups from these strata that were matched on predicted life expectancy: a “younger sub-group” with relatively poorer health/functional status and an “older sub-group” with relatively better health/functional status. We compared screening rates between sub-groups. Results: For all three cancer screenings, the younger sub-groups (average ages 73.4–76.1) had higher screening rates than the older sub-groups (average ages 83.6–86.9); screening rates were 42.9% versus 34.2% for prostate cancer screening (p = 0.02), 33.6% versus 20.6% for breast cancer screening (p < 0.001), 13.1% versus 6.7% for colorectal cancer screening in women (p = 0.006), and 20.5% versus 12.1% for colorectal cancer screening in men (p = 0.002). Conclusion: Among older adults with limited life expectancy, those who are relatively younger with poorer health and functional status are over-screened for cancer at higher rates than those who are older with the same predicted life expectancy.