Considerable uncertainty exists about the use of cancer screening tests
in older people, as illustrated by the different age cutoffs recommended by
various guideline panels. We suggest that a framework to guide individualized
cancer screening decisions in older patients may be more useful to the practicing
clinician than age guidelines. Like many medical decisions, cancer screening
decisions require weighing quantitative information, such as risk of cancer
death and likelihood of beneficial and adverse screening outcomes, as well
as qualitative factors, such as individual patients' values and preferences.
Our framework first anchors decisions through quantitative estimates of life
expectancy, risk of cancer death, and screening outcomes based on published
data. Potential benefits of screening are presented as the number needed to
screen to prevent 1 cancer-specific death, based on the estimated life expectancy
during which a patient will be screened. Estimates reveal substantial variability
in the likelihood of benefit for patients of similar ages with varying life
expectancies. In fact, patients with life expectancies of less than 5 years
are unlikely to derive any survival benefit from cancer screening. We also
consider the likelihood of potential harm from screening according to patient
factors and test characteristics. Some of the greatest harms of screening
occur by detecting cancers that would never have become clinically significant.
This becomes more likely as life expectancy decreases. Finally, since many
cancer screening decisions in older adults cannot be answered solely by quantitative
estimates of benefits and harms, considering the estimated outcomes according
to the patient's own values and preferences is the final step for making informed
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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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