Five questions with Jennifer Moss, PhD

Jennifer Moss, PhD, an assistant professor of family and community medicine at Penn State College of Medicine, recently published research about the cancer screening rates of older Americans. She reported that many older Americans are receiving cancer screenings past recommended ages – a situation called overscreening.

This study was partially supported by Penn State Clinical and Translational Science Institute through its support of co-author Gene Lengerich, VMD. A full interview with Moss about this study is available in episode 4 of the institute’s Engage podcast.

What is overscreening?

Overscreening for cancer is anytime someone gets a screening test to look for early signs of cancer or tumors that may develop into cancer, above or more than what’s recommended. So you might be screened more often than recommended, earlier than recommended, or in the case of this study, after an age when you’re no longer recommended to get screened.

What did you find in your research?

What we found is that more than half of older adults were overscreened for colorectal cancer, and about half for cervical cancer and 74% of women were over screened for breast cancer. So that’s a lot of tests for these older adults that are not routinely recommended; a lot of potential harms and risks from these tests, and costs to the healthcare system and to the patients themselves. Overscreening was more common in urban areas. For colorectal cancer, we saw that it was higher for women than for men.

Why might overscreening be more in urban areas?

These conversations about stopping or graduating out of screening can be really difficult and sensitive because they bring up issues about your general health status and life expectancy. Those are really difficult conversations to have. We know that in rural communities, patients tend to have longer-lasting, more trusting relationships with their providers. The quality of that relationship probably helps set up that conversation about aging out of screening.

Why should people talk to their doctors about screening decisions?

There are some valid reasons for people to continue getting screened after the upper age limit, which is for the general population. However, for people who have risk factors for cancer, or cancer history, it may still be appropriate to continue getting screened for cancer. We weren’t able to assess that in this study, but we know that patients and providers should continue having those conversations about screening. “Why is it appropriate for me and my health condition to get screened or not?” Ultimately, that’s a decision between a patient and the provider.

What kind of collaborations are you open to?

Our group is continuing this research on overscreening and, in general, health of older adults. We’re always looking for clinicians or researchers who have expertise in older adults, geriatrics, and preventative health review for the older adult population.

I do a lot of work on rural health and cancer prevention. That’s a particular interest in overscreening and a variety of other clinical and health issues. And in general, we’re interested in bridging the gap between the clinic and the community. So, right now, I’m in the Department of Family and Community Medicine, and we have great access to clinical populations, people who come into family medicine for care. But we also want to make sure that we’re capturing and we’re serving the population that doesn’t necessarily come into family medicine. Patients need to see other providers, and those are the collaborators I am particularly interested in.

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