Cancer in Adults Aged 85 and Older: Rates, Screening, and Survival
A new report published by DeSantis et al in CA: A Cancer Journal for Clinicians examined cancer statistics in adults 85 and older and found incidence and mortality trends are generally similar to those in people aged 65 to 84 years, but disease screening rates are unexpectedly high and survival is poorer.
Background
Adults aged 85 years and older—the “oldest old”—are the fastest-growing age group in the United States, yet relatively little is known about their cancer burden.
In 2019, there will be approximately 140,690 cancer cases diagnosed and 103,250 cancer deaths among the 85 and older population in the United States. The most common cancers in these individuals—lung, breast, prostate, and colorectal—are the same as those in the general population. Overall cancer incidence rates peaked in the oldest men and women around 1990 and have subsequently declined, with the pace accelerating during the past decade. This progress reflects declines in prostate and colorectal cancers, and more recently, in lung cancer among men and in breast cancer among women.
Methods and Findings
Researchers analyzed data from the National Cancer Institute, the North American Association of Central Cancer Registries, and the National Center for Health Statistics to provide comprehensive information on cancer occurrence in this population.
Their analysis showed that among men 85 and older, prostate and lung cancers are the most common causes of cancer death, accounting for 40% of cancer deaths. Among women, lung cancer is the leading cause of cancer death (19%), followed by breast cancer (13%). For men and women, colorectal cancer is the third-leading cause of cancer death, representing 9% and 12% of cancer deaths, respectively, in this population.
The authors also noted that patients aged 85 years and older are less likely to be diagnosed at an early stage compared to those aged 65 to 84 years. For example, 57% of breast cancers in the oldest old are diagnosed at a local stage vs 68% in patients 65–84 years old; for prostate cancer, it is 41% vs 77%, respectively. Late stage at diagnosis among the oldest old partly reflects less screening, which is generally not recommended for those aged 85 years and older because of diminished life expectancy, the higher prevalence of other serious medical conditions, and limited evidence of survival benefit. For most individuals in this age group, the small potential benefit of extending life is outweighed by the possible harms from screening, which increase with age.
Despite these recommendations, data from the National Health Interview Survey indicated unexpectedly high rates of cancer screening in adults aged 85 years and older. In 2015, more than one-third of women aged 85 years and older reported receiving a mammogram within the previous 2 years, and 18% reported receiving recent cervical cancer screening tests. More than one-half of adults aged 85 years and older reported receiving either a stool screening test within the past year or a sigmoidoscopy or colonoscopy within the past 5 to 10 years. Nearly 30% of men in this age group reported receiving a prostate-specific antigen test within the past year.
The analysis showed that people 85 years and older are also less likely to receive surgical treatment; only 65% of patients with breast cancer in this age group received surgery compared with 89% of those aged 65–84 years. This difference partly reflects the complexities of treating older patients—including the presence of multiple comorbidities, functional declines, and cognitive impairment—but also highlights potential undertreatment of otherwise fit older adults. Overtreatment of vulnerable individuals in this age group is also a concern. The authors noted that, importantly, age alone does not predict life expectancy, physical function, or the ability to tolerate treatment. They also provided information about tools to enable clinicians to evaluate the functional age of patients as part of the treatment decision-making process.
“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,” wrote the authors. “The rapid growth and diversification of the population aged 85 years and older will increase demand and complexities for cancer care and could have a substantial impact on medical care resource allocation. There is an urgent need to develop a more comprehensive evidence base to guide treatment decisions for these understudied patients with cancer through increased enrollment in clinical trials and to leverage research designs and infrastructure for generating evidence on older adults with cancer.”
Disclosure: For full disclosures of the study authors, visit onlinelibrary.wiley.com.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
