Cancer Prevention and Screening for Older Adults: Part 1. Lung, Colorectal, Bladder, and Kidney Cancer

Patrick P. Coll, MD, AGSF, CMD; Beatriz Korc-Grodzicki, MD, PhD, AGSF; Benjamin T. Ristau, MD, MHA; Armin Shahrokni, MD, MPH; Alexander Koshy, MD; Olga T. Filippova, MD, MSc; Imran Ali, MD, MS, MPH

Disclosures

J Am Geriatr Soc. 2020;68(10):2399-2406. 

In This Article

Abstract and Introduction

Abstract

The incidence of most cancers increases with age. Cancer is the second most common cause of death in older adults after cardiovascular disease. Many common cancers in older adults can be prevented from occurring or can be identified at an early stage and treated effectively. The prevention and identification of cancer in its early stages, in an attempt to reduce discomfort and disability associated with advanced cancer and cancer treatment, is also a priority. Overscreening for cancer in older adults can lead to unnecessary diagnostic testing and unnecessary treatment. Both older adults and their healthcare providers need guidance on the appropriate use of cancer prevention and screening interventions. This first of a two-part review addresses special considerations regarding cancer prevention for adults aged 65 and older. Screening decisions and the impact of limited life expectancy and an older adult's ability to tolerate cancer treatment are also addressed. Guidance is provided regarding the prevention and early identification of lung, colorectal, bladder, and kidney cancer in older adults. The prevention of breast, prostate, and female urogenital cancers are addressed in Part 2.

Introduction

Lifestyle changes, especially reduced rates of tobacco use, widespread cancer screening, and improved cancer treatment, have led to a decrease in both cancer incidence and cancer mortality in the United States. However, because the incidence of many cancers increases with increasing age, cancer incidence remains high in older adults. Cancer is the second most common cause of death in older adults after cardiovascular disease.[1–3] Cancer prevention is important for older adults, not only to reduce mortality, but also to reduce negative effects on quality of life associated with advanced cancer and side effects from cancer treatment.

Cancer prevention efforts are aimed at both preventing cancer from occurring and identifying cancer at an early stage (screening), with the understanding that most early cancers require less extensive treatment and have better outcomes. The prevention and early identification of cancer is an important component of healthy aging. Efforts to prevent cancer and identify early cancers in older adults need to consider cancer epidemiology, the clinical significance of the cancer, and the effectiveness, drawbacks, and cost of cancer prevention and screening. It is important that clinicians have a clear understanding of the prognosis with and without cancer treatment when discussing cancer screening with older adults.[4]

In this two-part review we provide information and guidance for healthcare providers regarding the prevention of nine solid organ cancers that are common in older adults. In addition to being common in older adults, we chose to address these cancers because there is evidence to support, adjust, or avoid prevention efforts in older adults. Part 1 reviews lung, colorectal, bladder, and kidney cancer prevention. Part 2 addresses breast, prostate, and female urogenital cancers.

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