An Update on Cancer Screening in Older Adults

Members of the College of Family Physicians of Canada may claim one non-certified credit per hour for this non-certified educational program.

Shabbir M.H. Alibhai, MD, MSc, FRCP(C), Staff Physician, University Health Network, Toronto, ON, Canada, Assistant Professor, Departments of Medicine and Health Policy, Management, and Evaluation, University of Toronto, Research Scientist, Canadian Cancer Society

More than one-half of new cancers and over 70% of cancer deaths occur in adults age 65 or older. Systematic screening has been associated with reductions in cancer- related mortality for a variety of cancers, including breast, cervical, and colorectal cancer. Prostate cancer screening remains more controversial despite the recent publication of two large randomized trials of screening. Although guidelines are beginning to address cancer screening specifically among the growing group of seniors age 70 or older, there is virtually no guidance on estimating remaining life expectancy or considering competing causes of mortality (e.g. comorbid medical illness) in this age group. In this article, I review evidence-based guidelines for cancer screening in adults and discuss the limitations of screening studies with respect to older adults. I have also highlighted new evidence and substantive updates to guidelines since the last publication on cancer screening in Geriatrics & Aging five years ago.

Keywords: cancer screening, aged, mass screening.


I believe we are doing far too much prostate surgery based not so much on evidence but on hunch.

I would hope that some study could come up with a NNT number to answer my simple question.

How many men need to be treated with prostate surgery in order to change the survival date of one man significantly?

My bet, it is likely 1 in 200 which means that the other 199 men have their lives changed forever by the surgery and the diagnosis. I should know. I had the surgery and regret it.  Looking backward, I should have taken my chances.

Let this be a cautionary tale to many of my colleagues. Medicine, like economics, is far from an exact science