• James S Goodwin, Kristin Sheffield, Shuang Li, and Alai Tan.
• Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX, USA. jsgoodwi@utmb.edu.
• J Gen Intern Med. 2016 Nov 1; 31 (11): 130813141308-1314.

BackgroundObtaining cancer screening on patients with limited life expectancy has been proposed as a measure for low quality care for primary care physicians (PCPs). However, administrative data may underestimate life expectancy in patients who undergo screening.ObjectiveTo determine the association between receipt of screening mammography or PSA and overall survival.DesignRetrospective cohort study from 1/1/1999 to 12/31/2012. Receipt of screening was assessed for 2001-2002 and survival from 1/1/2003 to 12/31/2012. Life expectancy was estimated as of 1/1/03 using a validated algorithm, and was compared to actual survival for men and women, stratified by receipt of cancer screening.ParticipantsA 5 % sample of Medicare beneficiaries aged 69-90 years as of 1/1/2003 (n = 906,723).InterventionsReceipt of screening mammography in 2001-2002 for women, or a screening PSA test in 2002 for men.Main MeasuresSurvival from 1/1/2003 through 12/31/2012.Key ResultsSubjects were stratified by life expectancy based on age and comorbidity. Within each stratum, the subjects with prior cancer screening had actual median survivals higher than those who were not screened, with differences ranging from 1.7 to 2.1 years for women and 0.9 to 1.1 years for men. In a Cox model, non-receipt of screening in women had an impact on survival (HR = 1.52; 95 % CI = 1.51, 1.54) similar in magnitude to a diagnosis of complicated diabetes or heart failure, and was comparable to uncomplicated diabetes or liver disease in men (HR = 1.23; 1.22, 1.25).ConclusionsReceipt of cancer screening is a powerful marker of health status that is not captured by comorbidity measures in administrative data. Because life expectancy algorithms using administrative data underestimate the life expectancy of patients who undergo screening, they can overestimate the problem of cancer screening in patients with limited life expectancy.

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