Nonadherence to Cancer Screening Associated With Mortality Unrelated to Cancer

A study of more than 60,000 individuals indicated that those who do not adhere to cancer screening guidelines are at an increased risk of all-cause mortality unrelated to cancer malignancies. This finding came from a secondary analysis of the Prostate, Lung, Colorectal and Ovarian Cancer Screening (PLCO) trial and was published in JAMA Internal Medicine.

Researchers randomized patients from 10 U.S. screening centers between November 8, 1993, and July 2, 2001. Patients were originally followed for 13 years or through December 31, 2009, but participants re-consented to further follow-up starting May 18, 2011, and were observed through December 31, 2012. A total of 64,567 patients (29,537 women and 35,030 men; mean age = 62.3 years) were included in the analysis.

This is why as treated analysis is problematic: 64k participant RCT of cancer screening shows those who were nonadherent to ca screening had increased non-cancer mortality. File this away to rebut those who want to do per protocol/as treated analyses.https://t.co/60scT1QrtM pic.twitter.com/alhVXgV6OY

— Venk Murthy MD PhD (@venkmurthy) December 28, 2018

At baseline, participants completed a self-administered questionnaire. Individuals were classified as those receiving all sex-specified PLCO cancer screening tests at baseline (adherent; n=55,065; 85.3%), those receiving some baseline tests (partially adherent; n=2,548; 3.9%), and those receiving no baseline tests (nonadherent; n=6,954; 10.8%).

At 15 years of follow-up, there were 7,966 deaths, excluding those from the cancer, among patients who were adherent, 449 deaths among those who were partially adherent, and 1,395 deaths among those who were nonadherent.

Within 10 years of follow-up, the hazard ratio (HR) of mortality, excluding deaths from cancers and controlling only for age, sex, and race/ethnicity (model 1), was 1.73 (95% CI, 1.60-1.89) for nonadherent individuals compared with adherent participants. The HR of mortality was 1.36 (95% CI, 1.19-1.54) for partially adherent individuals compared with fully adherent participants.

Why Is Nonadherence to #Cancer #Screening Associated With Increased Mortality? https://t.co/2HEoMYanEf

— Ray DuBois, MD, PhD (@Rndubois) January 2, 2019

After adjusting for medical risk factors for mortality and behavioral-related factors such as obesity and smoking (model 2), the HR decreased to 1.46 (95% CI, 1.34-1.59) for nonadherent patients compared with adherent participants. Those who did not undergo screenings were 46% more likely to die compared with 26% of those who skipped some screenings.

“It was not a direct effect of missing the cancer screening that led to the increased mortality in the noncompliers,” Paul Pinsky, PhD, of the National Cancer Institute, told Reuters. “Rather, we believe that noncompliance with the screening was a marker of a wider health behavioral profile of general noncompliance with or nonadherence to medical tests and treatments. Non-compliance with medical procedures has also been linked, in this and other studies, to other unhealthy lifestyle factors such as obesity and smoking, and to lower education.”

In a large cancer screening trial, nonadherence to cancer screening tests was associated with increased mortality among middle-aged and older adults (excluding screened for cancers) https://t.co/0mHdULQHmU

— Joseph Ross (@jsross119) December 29, 2018

An analysis of pros and cons of colorectal cancer screening at age 45.

Cost-effectiveness and benefit-to-harm ratio of risk-stratified screening for breast cancer.

Source: JAMA Internal Medicine