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How old is too old for cancer screening? (Feb-11)

Cancer screening is generally recommended for people over the age of 50. Screening tests, such as colonoscopies, mammograms and PSAs (prostatespecific antigen), can help detect cancer at an early stage andprevent deaths. These screening tests, however, do have risks so,along with their doctor, people need to make a decision about howoften to get screened and when or if one should stop gettingscreened.

Consider the question:

Now, imagine that you were screened for cancer about a year ago and no cancer was found. You and your doctor are talking about when you should come back for screening in the future. Your doctor explains that cancer screening guidelines recommend that you do come back for more screening tests but as you get older, screening for cancer is no longer a good option. Your doctor states that you should follow this recommendation as you age. Now, imagine that you were screened for cancer about a year ago and no cancer was found. You and your doctor are talking about when you should come back for screening in the future. Your doctor explains that cancer screening guidelines recommend that you do come back for more screening tests but as you get older, screening for cancer is no longer a good option. Your doctor states that you should follow this recommendation as you age.

 
Would you plan to stop getting screening tests for cancer at a certain age?
  • Yes
  • No

How do your answers compare?

In a recent study published in the Journal of General Internal Medicine, CBSSM Investigators and Mick Couper and Brian J. Zikmund-Fisher, together with lead author Carmen Lewis (Department of Medicine, University of North Carolina) and several co-authors, explored decisions about stopping cancer screening tests. This study was part of the DECISIONS study, a large survey of U.S. adults about common medical decisions.
 
Recently, the US Preventive Services Task Force recommended against prostate screening for men aged 75 and older, and recommended against routine screening for CRC screening after age 75 and any CRC screening after age 85. Cancer screening for prostate cancer, CRC and breast cancer helps to detect cancer at an early stage when they are easier to treat. However, as a person gets older, the risks of these tests become larger than the benefits.
Data was collected from 1,237 individuals aged 50 and older who reported having made one or more cancer screening decisions in the past 2 years. Participants were asked about their plans of whether or not to stop cancer screening as well as characteristics of themselves and their health care provider.
 
Only 9.8% of people planned to stop getting screened for cancer when they reached a certain age. This percentage varied by type of cancer, age and race of the participant and how much the participant was responsible for the decision apart from their health care professional.
 
Of the 119 people who gave a specific age that they planned to stop getting cancer screening the average age they did or plan to stop was 74.8 for breast cancer, 76.8 for colon cancer and 82.9 for prostate cancer.
 
The study authors concluded that “plans to stop screening were uncommon among participants who had recently faced a screening decision”. They also concluded that further research is needed to understand how people think about the risks and benefits of screening when life expectancy is short and that education around this topic may be beneficial.
 

To learn more about this study, see:

 

The novelty of risk and vaccination intentions (May-12)

It's 2009.  Early in the year, a 9-year-old girl from California became the first person with a confirmed case of H1N1 ("swine") influenza in the United States.  Shortly thereafter, the U.S. declared a public health emergency and the World Health Organization declared a phase 6 pandemic (the highest level possible).  By September 2009 a vaccination was developed and was available within a month.

You've been following the news about the H1N1 influenza as developments have unfolded throughout the year, and you feel some concern.  You have been wondering about the risk of coming down with the H1N1 flu yourself and have been thinking about whether you should be vaccinated. 

Thu, May 26, 2011

Raymond De Vries was appointed Professor of Midwifery Science at the University of Maastricht (Netherlands) in November 2010.  As is the custom in European universities, he delivered an inaugural lecture, outlining the educational and research goals of his professorship on May 26, 2011.  It was preceded by a research symposium focusing on risk in maternity care, with speakers exploring the way risk is measured and used by care providers and the way pregnant women respond to assessments of risk they are given. Click here to view a video of his inaugural address, which is in English. Click here for a news article about Dr. De Vries, in Dutch.

Tue, September 20, 2011

The CBS News website recently featured 10 tips to make better decisions about cancer care from U-M’s Angela Fagerlin, Ph.D., associate professor of internal medicine. Below is an excerpt from the article:

Cancer is scary, and doctors sometimes sound as if they’re speaking a foreign language when talking about the disease and its treatment. But “people are making life and death decisions that may affect their survival and they need to know what they’re getting themselves into,” says Fagerlin “Cancer treatments and tests can be serious. Patients need to know what kind of side effects they might experience as a result of the treatment they undergo.”

 

Raymond De Vries is co-author on a new publication in Academic Medicine, highlighting a successful model for collaboration which was developed in the early phases of a grant funded by the Bill & Melinda Gates Foundation nearly five years ago. The Collaborative Health Alliance for Reshaping Training, Education, and Research (CHARTER) project expanded the partnerships between the University of Michigan and several Ghanaian academic institutions to enhance health care provider education and build and/or increase research capacity. One of the early goals of the grant was to establish guiding principles for engagement through a Charter of Collaboration.


Read more about the partnership through UMHS News and the origional PubMed article.

Thu, February 26, 2015

Raymond De Vries, Co-Director of CBSSM,  Kerry Ryan, H. Myra Kim, and Scott Kim are co-authors on a recently published JAMA Research Letter entitled, “Moral Concerns and the Willingness to Donate to a Research Biobank.”  Tom Tomlinson, PhD from MSU is the first author.

Listen here to Dr. De Vries discussing the findings on Michigan Radio's Stateside program.
 

Research Topics: 
Tue, March 10, 2015

Beth Tarini MS, MD shared the findings of her research in a news article on the UMHS website. The research explores parents' perspectives on genomic sequencing for themselves and their children. "Particularly fascinating was that parents’ interest for having predictive genetic testing done for themselves reflected their interest in testing their children too – it appears to be a global decision for the family," Tarini explained. The study will be published in this month's issue of Public Health Genomics.

Research Topics: 

The August 2016 issue of AMA Journal of Ethics features commentaries by Christian Vercler, Lauren Smith, and Andrew Shuman.

"Is Consent to Autopsy Necessary? Cartesian Dualism in Medicine and Its Limitations"
Commentary by Megan Lane and Christian J. Vercler

"I Might Have Some Bad News: Disclosing Preliminary Pathology Results"
Commentary by Michael H. Roh and Andrew G. Shuman

"Requests for VIP Treatment in Pathology: Implications for Social Justice and Systems-Based Practice"
Commentary by Virginia Sheffield and Lauren B. Smith

http://journalofethics.ama-assn.org/site/current.html

Research Topics: 

Darin Zahuranec’s survey study, “Variability in physician prognosis and recommendations after intracerebral hemorrhage” published in Neurology found that physicians vary substantially in ICH prognostic estimates and treatment recommendations. This study suggests that variability could have a profound effect on life and death decision-making and treatment for ICH.


Several CBSSM-affiliated faculty and alumni were co-authors: Angie Fagerlin, Meghan Roney, Andrea Fuhrel-Forbis, and Lewis Morgenstern.


http://ihpi.umich.edu/news/survey-severe-stroke-prognoses-differ-depending-doctor

Lauren Smith, MD

Faculty

Dr. Lauren Smith is a Clinical Associate Professor in the Department of Pathology at the University of Michigan specializing in hematopathology.  She has been a member of the University of Michigan Adult Ethics Committee since 2005 and also serves as a Chair of the Michigan State Medical Society Ethics Committee.  Her research interests include ethical issues in clinical medicine and pathology.

 
Research Interests: 
Last Name: 
Smith

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