{"entity":{"id":"idea-prev-screening-stop-by-life-expectancy","kind":"idea","name":"Stop screening by life expectancy, not birthday, with a tool in the record","aka":[],"tldr":"Screening someone unlikely to live ten years causes harm without benefit. A life-expectancy estimate in the medical record could stop invitations and prompt a conversation.","summary":"Screening someone unlikely to live ten years causes harm without benefit, while healthy older adults are excluded by birthday, so this idea embeds an ePrognosis-type life-expectancy tool in the medical record to gate screening invitations and prompt a conversation. Individualised cessation is guideline-endorsed but not implemented, and deprescribing frameworks show it can be done. The aim is less screening in people with under ten years of life expectancy and more in healthy older adults, with patient acceptance measured. The test is a cluster RCT in primary care with over-screening and under-screening as endpoints. At early-clinical maturity it addresses the bottlenecks Overdiagnosis and false alarms and Older and multimorbid patients are excluded and undertreated.","asOf":"2026-09-08","links":[{"label":"Bottleneck evidence (Overdiagnosis and false alarms): Welch & Black, Overdiagnosis in cancer (JNCI 2010)","url":"https://doi.org/10.1093/jnci/djq099"}],"tags":[],"related":[],"cancers":[],"sections":["early-detection"],"technologies":["geriatric-assessment"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-overdiagnosis","b-aging-comorbidity"],"keyPapers":["paper-welch-j-natl-cancer-inst"],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"Life-expectancy gating reduces screening in people with under ten years' expectancy by at least 30% and increases it in healthy older adults, with patient acceptance of at least 80%.","rationale":"Individualised cessation is guideline-endorsed but not implemented; deprescribing frameworks show it can be done.","test":"Run a cluster RCT in primary care.","maturity":"early-clinical","actor":"clinic","cost":"small","horizonYears":3},"route":"/ideas/idea-prev-screening-stop-by-life-expectancy/","neighbours":{"section":[{"id":"early-detection","kind":"section","name":"Early Detection & Screening","route":"/fronts/early-detection/"}],"technology":[{"id":"geriatric-assessment","kind":"technology","name":"Geriatric assessment","route":"/technologies/geriatric-assessment/"}],"bottleneck":[{"id":"b-aging-comorbidity","kind":"bottleneck","name":"Older and multimorbid patients are excluded and undertreated","route":"/bottlenecks/b-aging-comorbidity/"},{"id":"b-overdiagnosis","kind":"bottleneck","name":"Overdiagnosis and false alarms","route":"/bottlenecks/b-overdiagnosis/"}],"paper":[{"id":"paper-welch-j-natl-cancer-inst","kind":"paper","name":"Overdiagnosis in cancer","route":"/key-papers/paper-welch-j-natl-cancer-inst/"}]}}