December 13, 2011
Older Americans Still Getting Routine Cancer Screening
Researchers said on Monday that although the benefits of cancer screening in elderly people are less certain than the risks, many older Americans are still getting the routine tests.
In a survey, over half of women between 75 and 79 said they were being screened for breast cancer and had a recent Pap smear to look for signs of cervical cancer.
The number of elderly people who were screened for cancers over 80 dropped some, but they were still high despite uncertainty over the potential benefits of screening tests in the elderly.
"Historically older adults have been excluded from screening trials, so the screening efficacy data in this population are really limited," Keith M. Bellizzi, a public health researcher at the University of Connecticut, who lead the new work, told Reuters.
Some screening tests have downsides, such as the cost of looking for disease in people who are healthy. Another downside is the potential complications of procedures like colonoscopies.
The tests may also sound false alarms that can lead to unnecessary biopsies.
The benefits outweigh the risks in younger adults, but as people age the benefits seem to be flipped the other way around.
"At a minimum, in order to see any benefit of screening, you would want your patient to have a life expectancy of more than five years," Bellizzi told Reuters Health.
He said that screening people who have other health problems may also require extra thought as well.
"If you are going to screen in older adults for a cancer, you wouldn't want to do that unless you're sure that individual would be able to tolerate that treatment," Bellizzi told Reuters.
The researchers used data on over 4,000 elderly people and found that 57 percent had been screened for colon cancer, and 56 percent of men had been screened for prostate cancer.
They also found that 62 percent of women between the ages of 75 and 79 had been screened for breast cancer within the past two years, and 53 percent had been screened for cervical cancer during the past three years.
The U.S. Preventive Services Task Force either recommends against routine screening of people 75 and older, or says that evidence is insufficient to balance the benefits and harms.
The American Cancer Society has no upper age limit for its colon cancer recommendations, but says that men whose life expectancy is less than 10 years should not be offered prostate cancer screening.
Bellizzi said it is difficult to separate the group of seniors who may be healthy and have a long life ahead of them, and those who may be very unlikely to get anything but harm from screening.
"Over 50 percent of physicians are continuing to recommend screening tests in older men and women," he told Reuters. "I'm hopeful that these findings will serve as a catalyst for an important dialogue that needs to take place."
He said that elderly citizens who face the choice of whether or not to get screened should weigh their options with their physicians based on their personal values and preferences.
"I would recommend for patients to have a real thoughtful conversation with their provider to talk about the potential harms and benefits of screening," Bellizzi told Reuters.
The research was published in the Archives of Internal Medicine.
On the Net:
- University of Connecticut
- U.S. Preventive Services Task Force
- American Cancer Society
- Archives of Internal Medicine