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43 - novembre 2018 - Minuti discussione con il paziente sull’opportunità di in- terrompere lo screening , inmodo da far abituare il pa- ziente al concetto che prima o poi giunge un mo- mento in cui i rischi associati allo screening superano i potenziali beneþci. 79 La discussione tramedico e pa- ziente su questi argomenti va ripetuta ad intervalli pe- riodici. È importante che il paziente capisca che la de- cisione di interrompere lo screening non si traduce in una ridotta assistenza. La discussione dovrà invece fo- calizzarsi sull’identiþcazione di strategie di promo- zione della salute che hanno le migliori probabilità di ottenere eûetti beneþci nell’immediato futuro, come ad esempio programmi di esercizio þsico e di vacci- nazioni. Fonti dei dati: È stata condotta una ricerca bibiograþca su PubMed in Clinical Queries utilizzando le parole chiave can- cer, screening, older adults, elderly . La ricerca ha ri- guardatometa-analisi, studi clinici randomizzati con- trollati, studi clinici, review . Una ricerca bibliograþca è stata inoltre condotta utilizzando le seguenti fonti: Cochrane Database of Systematic Reviews, USPSTF, National Guideline Clearinghouse, Agency for He- althcare Research andQuality Evidence Reports, Es- sential Evidence Plus, UpToDate. Date di esecuzione delle ricerche: da 1 Gennaio 2015 a 2 Marzo 2016. NOTA: La presente review rappresenta un aggiornamento del precedente articolo di Albert et al. 80 Gli autori La Dr. Brooke Salzman è Associate Professor , De- partment of Family andCommunityMedicine,úo- mas Jeûerson University, di Philadelphia, Pennsyl- vania (Stati Uniti). La Dr. Kathryn Beldowski è At- tending Physician , Division of Geriatric Medicine, Crozer-Chester Medical Center, di Upland, Pen- nsylvania. La Dr. Amanda De La Paz è Assistant Pro- fessor , Department of Family, Community and Preventive Medicine, Drexel University College of Medicine, di Philadelphia, Pennsylvania. Note bibliografiche 1. American Cancer Society. Cancer facts and figures 2015. http://www.cancer.org/acs/groups/content/@ editorial /docu- ments/document/acspc-044552.pdf. Accessed February 8, 2015. 2. Walter LC, et al. Relationship between health status and use of screeningmammography and Papanicolaou smears among women older than 70 years of age. Ann InternMed. 2004; 140(9): 681-688. 3. Walter LC, Lindquist K, Nugent S, et al. Impact of age and co- morbidity on colorectal cancer screening among older veterans. Ann InternMed. 2009;150(7):465-473. 4. Schonberg MA, McCarthy EP, Davis RB, Phillips RS, Hamel MB. Breast cancer screening in women aged 80 and older: results from a national survey. J Am Geriatr Soc. 2004;52(10):1688- 1695. 5. MehtaKM, FungKZ, Kistler CE, ChangA,Walter LC. 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Screening for prostate cancer: U.S. Preventive Services Task Force recommendation statement. Ann InternMed. 2012; 157(2):120-134. 18. American Academy of Family Physicians. Clinical preventive service recommendation. Prostate cancer. http://www.aafp.org/pa- tient-care/clinical-recommendations/all/prostate-cancer.html. Ac- cessed December 15, 2015. 19. American Cancer Society. Prostate cancer prevention and early detection. Updated January 6, 2015. http://www.cancer.org/ acs/groups/cid/documents/webcontent /003182-pdf.pdf. Accessed Janaury 7, 2016. 20. Carter HB, Albertsen PC, Barry MJ, et al. Early detection of prostate cancer: AUAGuideline. J Urol. 2013;190(2):419-426. 21. Committee on Practice Bulletins—Gynecology. ACOG prac- tice bulletin number 131: screening for cervical cancer. Obstet Gy- necol. 2012; 120(5):1222-1238.