‘Carry on’ screening - most older adults in England want to continue being invited for routine cancer screening
Christian von Wagner is a Senior Lecturer at the UCL Health Behaviour Research Centre. His paper Continuing cancer screening later in life: attitudes and intentions among older adults in England invited was recently published in Age and Ageing.
The rise in life expectancy, together with age-related increase in the incidence of most cancers, has led to mounting interest in cancer screening in older people. In England, routine cervical screening invitations continue to age 64 years, breast screening to 70 and bowel cancer screening to age 75. Even after routine invitations stop older people can still request bowel and breast cancer screening.
A recent survey commissioned by the Cancer Research UK and conducted by researchers from UCL and the University of Edinburgh looked at public attitudes to rules about stopping cancer screening for older people. Among the 927 people aged 60 to 74 most did not agree that screening programmes should stop inviting older people routinely. They wanted to have a strong recommendation to opt in, preferably from their GP. Importantly, despite the enthusiasm for being invited, only about a quarter of people indicated that they would carry on screening beyond the stoppage age. This suggests that the offer of screening may be valued as much as the test itself.
The decision to include a participant in cancer screening needs to weigh up the potential benefits against an individual’s ability to tolerate the test and any potential treatment. This balance is likely to become increasingly complex and dependent on individual circumstances as people grow older and develop other health problems. Thus, as people grow older, the decision to screen might benefit from a more personalised and ‘negotiated’ approach, possibly involving active support from primary care. There is a need for guidance for GPs and other healthcare providers who might be involved in discussing screening options with patients who are approaching the upper age limit for screening programmes.