Report Shows Higher-Than-Expected Cancer Screening, Poorer Outcomes in Oldest Age Group

A new report suggests a similar cancer burden among adults aged 65 to 84 years and those 85 years and older, but higher-than-expected screening and lower survival in the older age group.

Prior to the study, relatively little was known about cancer incidence and mortality trends in adults aged 85 years and older, despite being the fastest-growing age group in the United States. Published in CA: A Cancer Journal for Clinicians, the findings provide a snapshot of the cancer burden in the US population’s oldest age group.

Among the 85 and older US population, the report estimated that approximately 104,690 cancer cases will be diagnosed and 103,250 cancer deaths will occur in 2019. The most common cancers in this age group reflect those in the general population: lung, breast, prostate, and colorectal.

Prostate and lung cancers are the most common cause of cancer mortality among men age 85 and older, accounting for 40% of cancer deaths, the study found. Among women, lung cancer is the leading cause of cancer death (19%), followed by breast cancer (13%). For both men and women, colorectal cancer represented 9% and 12% of cancer deaths, respectively, in this group.

Additionally, the report authors noted that patients in the older age group are less likely to be diagnosed with early-stage disease, compared with those ages 65 to 84, partly because screening is generally not recommended in the older population. However, the data showed higher-than-expected rates of screening among adults age 85 and older. For example, in 2015, more than one-third of women in this age group reported receiving a mammogram within the previous 2 years and 18% reported receiving a cervical cancer screening test.

Even so, those 85 years and older are also less likely to receive surgical treatment, due to the complexities of treating older patients. According to the report, only 65% of patients aged 85 years and older with breast cancer received surgery compared with 89% of those aged 65 to 84 years.

In terms of survival, the data showed that survival is 35% lower in adults aged 85 years and older compared with those aged 65 to 84 years for regional-stage prostate cancer and from 19% to 23% lower for those with local-stage lung and bladder cancers and regional-stage breast cancer.

Challenges in treatment in this population likely contribute to poorer survival for older patients, but the authors noted that studies also suggest older patients have benefited less than younger patients from recent advances in cancer therapy, whether due to lower efficacy or use of ineffective doses.

Furthermore, the authors listed undertreatment of otherwise fit older adults and the overtreatment of vulnerable individuals as significant challenges. Balancing the risks of undertreatment versus overtreatment is important to consider for patients in this age group, they wrote.

“More research on cancer in the oldest Americans is needed to improve outcomes and anticipate the complex health care needs of this rapidly growing population,” the authors concluded.

References

DeSantis CE, Miller KD, Dale W, et al. Cancer statistics for adults aged 85 years and older, 2019. CA: A Cancer Journal for Clinicians. https://doi.org/10.3322/caac.21577