Annals of Family Medicine -- Comments for Jerant et al., 2 (5) 481-487

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Original Research:
Anthony F. Jerant, Peter Franks, J. Elizabeth Jackson, and Mark P. Doescher
Age-Related Disparities in Cancer Screening: Analysis of 2001 Behavioral Risk Factor Surveillance System Data
Ann Fam Med 2004; 2: 481-487 [Abstract] [Full text] [PDF]

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Electronic letters published:

Is Ageism a Factor in Cancer Screening?: Syed M. Ahmed, Barbra Beck, Marie Wolff, Tovah Bates (10 October 2004)

Is Ageism a Factor in Cancer Screening? 10 October 2004

Syed M. Ahmed,
Milwaukee, USA
Associate Professor, Dept. of Family and Community Medicine, Medical College of Wisconsin,
Barbra Beck, Marie Wolff, Tovah Bates
Send response to journal:
Re: Is Ageism a Factor in Cancer Screening?

This article addresses a significant issue of appropriate care for geriatric patients in America. The focus of the article is to examine the issues of ageism as a backdrop for the disparity in screening for breast, colorectal, and prostate cancers. The authors conclude that significant age related disparities appear to exist although they question whether ageism is a root cause of this disparity. This study finds that physician screening patterns are sometimes counter-intuitive and cannot be explained by systemic ageism bias. However, when we under use or overuse any screening procedure at any age, it points toward our collective “lack of knowledge.” Appropriate evidence-based screening at any age is good clinical practice. More screening does not always mean better patient outcomes. Numerous guidelines from different specialty groups have been widely disseminated to practicing physicians, however the diffusion and adoption of these guidelines in actual practice still lags. In addition different specialty groups may promulgate conflicting guidelines. A survey or interview methodology that aims to discover physicians’ thinking regarding the recommendation of specific screening procedures may better illuminate the clinical decision making process.
A general concern about using the BRFSS, a self-report phone survey, is the potential for error as a result of health literacy limitations on the part of respondents. For instance, to determine if someone had been screened for colorectal cancer, the respondents were asked if they had had a fecal occult blood test within the previous 2 years, flexible sigmoidoscopy within the previous 5 years or colonoscopy within the previous 10 years. Respondents of all age groups may not know what these tests screen for, and therefore may not have answered the questions accurately. Response inaccuracies rooted in a misunderstanding of the question may have also occurred when respondents were asked if they had had a PSA or mammogram within the past two years. Without further information about how the questions were asked, or what, if any explanation for the screenings was provided, it is impossible to determine if health literacy affected the results.
This study raises interesting and important questions for further research. More studies need to be done to explore if ageism is an operative factor in our decision making. It is a demographic imperative that we learn how to take care of our older population given the significant graying of America. We will not be able to bridge the geriatric gap if we do not challenge ourselves to examine our underlying assumptions and the extent of our knowledge.
Competing interests: None declared