UCSF Department Of Medicine | Division of Geriatrics

Dr. Walter is a clinician-researcher who is a national leader in evaluating the real-world risks and benefits of cancer screening in older patients. Dr. Walter received her MD from Stanford University in 1995. She completed a residency in internal medicine and a fellowship in geriatrics at UCSF. Dr. Walter joined the UCSF faculty in July 2001, and she is a staff physician at the San Francisco VA.

Her experience as a doctor caring for older patients informs her research. She has often said "the advantage of being a clinician-researcher is that you know what would really help improve the care of your patients, so you know what questions to ask in your research." Dr. Walter's research is focused on how age and health affect the outcomes of cancer screening to better inform individualized screening decisions.

Dr. Walter is Principal Investigator on a National Cancer Institute R01 grant to determine the downstream consequences of prostate-specific antigen screening in older men and Principal Investigator on a K24 mentoring award from the National Institute on Aging. She is Associate Director of the UCSF CTSI Career Development (KL2) Program and Associate Editor for the JAMA series, "Care of the Aging Patient: From Evidence to Action."

Clinical Activities

Dr. Walter provides care for elderly veterans at the San Francisco VA. She is a primary care geriatrician for about one hundred older veterans at the San Francisco VA who have an average age of at least 80. She also attends on the Inpatient Medical Service and Acute Care for Elders (ACE) Unit at the San Francisco VA.

Research Activities

Dr. Walter's research focuses on cancer screening in older people. Her work addresses clinical questions such as “How do you decide who is most likely to benefit from a screening test, and who is most likely to be harmed?” Her goal is to help clinicians and patients make individualized screening decisions that do not rely simply on age cutoffs but take a patient's preferences and health into account.

Dr. Walter developed a conceptual framework to guide cancer screening decisions in a more sensible way than relying on age alone. Since her framework was published in 2001, it has appeared in numerous national guidelines and is widely used in medical schools to teach decision-making. She has also led a series of high-impact studies that use this framework to identify ways to improve current screening practices. Through her research she has become a leader in the national conversation about cancer screening in older adults.

The goal of Dr. Walter's research is to help clinicians avoid a "one-size-fits-all approach" to cancer screening. Dr. Walter says, "As a group, older people are really diverse, from bed-bound nursing home patients to individuals who are out hiking and running marathons. The decision to screen or not should reflect the situation of the individual, not just their age."

Selected Publications:

Dr. Walter’s scholarship focuses on improving cancer screening and prevention in older adults and on mentoring the next generation of clinical investigators.
Selected Publications:

Walter LC, Covinsky KE. Cancer screening in elderly patients: a framework for individualized decision making. JAMA 2001;285:2750-2756.
Walter LC, Brand RJ, Counsell SR, Palmer RM, Landefeld CS, Fortinsky RH, Covinsky KE. Development and validation of a prognostic index for 1-year mortality in older adults after hospitalization. JAMA 2001;285:2987-2994.
Walter LC, Eng C, Covinsky KE. Screening mammography for frail older women: what are the burdens? J Gen Intern Med. 2001;16:779-784.
Walter LC, Lindquist K, Covinsky KE. Relationship between health status and use of screening mammography and Papanicolaou smears among women older than 70 years of age. Ann Intern Med. 2004;140:681-688.
Walter LC, Davidowitz NP, Heineken PA, Covinsky KE. Pitfalls of converting practice guidelines into quality measures: lessons learned from a VA performance measure. JAMA 2004; 291:2466-2470.
Walter LC, Bertenthal D, Lindquist K, Konety BR. PSA screening among elderly men with limited life expectancies. JAMA 2006;296:2336-2342.
Williams BA, Lindquist K, Sudore RL, Covinsky KE, Walter LC. Screening mammography in older women: effect of wealth and prognosis. Arch Intern Med. 2008;168:514-520.
Walter LC, Lindquist K, Nugent S, Schult T, Lee SJ, Casadei MA, Partin MR. Impact of Age and Comorbidity on Colorectal Cancer Screening Among Older Veterans. Ann Intern Med. 2009; 150:465-473.
Mehta KM, Fung KZ, Kistler CE, Chang A, Walter LC. Impact of cognitive impairment on screening mammography use in older US women. Am J Pub Health 2010;59:1206-1216.
Kistler CE, Kirby KA, Lee D, Casadei MA, Walter LC. Long-term outcomes following positive fecal occult blood test results in older adults: benefits and burdens. Arch Intern Med. 2011;171:1344-1351.