The Medical Tests Some People Over 65 May Not Need
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Nobody wants to be subjected to medical tests they don’t need, but that’s exactly what’s happening to thousands of people across the U.S., according to a new study published online by JAMA Internal Medicine.
In the study, researchers evaluated rates of colorectal, cervical, prostate, and breast cancer screening in people 65 or older using data from the National Health Interview Survey from 2000 through 2010. A total of 27,404 participants were grouped by their risk of dying during the next nine years from an illness other than the type of cancer involved in the screening.
Approximately half of the men screened for prostate cancer were deemed likely to die in the next nine years. Roughly one-third of women screened for cervical or breast cancer similarly had a high risk of death. For both men and women, 41 percent of those who were screened for colorectal cancer should not have undergone the screenings because they, too, had a very high risk of mortality for the same time period.
In other words, a high percentage of people who were very sick still got a cancer screening test that offered them virtually zero benefit, because detecting early signs of cancer isn’t beneficial for those who are going to die of something else in the next several years, whether it be old age or another illness.
The findings raise concerns about excessive screening, “which not only increases health care expenditure but can lead to patient net harm,” writes lead author Trevor J. Royce at the University of North Carolina at Chapel Hill.
“Creating simple and reliable ways to assess life expectancy in the clinic may allow reduction of unnecessary cancer screening, which can benefit the patient and substantially reduce health care costs,” added Royce.
"It is particularly important to question screening strategies for older persons,” writes Cary P. Gross, M.D., of the Yale University School of Medicine, in a related commentary.
“Patients with a shorter life expectancy have less time to develop clinically significant cancers after a screening test and are more likely to die from non-cancer health problems after a cancer diagnosis,” added Gross
Yahoo Health reached out to Richard C. Wender, M.D., chief cancer control officer at the American Cancer Society for some clarity on subject of cancer screenings.
Wender notes that cancer screening remains “critically important,” especially for people who are not at high risk of dying during the next several years.
“The biggest recommendation for everyone is to have a conversation with your physician about cancer screening,” said Wender.
The American Cancer Society recommends the following screening guidelines for most adults:
Annual mammograms are recommended starting at age 40 and continuing for as long as a woman is in good health. Women in their 20s and 30s should undergo a clinical breast exam about every three years and then every year once they turn 40.
Colorectal cancer (and the presence of polyps)
Beginning at age 50, both men and women should follow one of these screening schedules:
-Flexible sigmoidoscopy (a procedure used to see inside the sigmoid colon and rectum) every five years
-Colonoscopy every 10 years, or double-contrast barium enema every five years
-CT colonography (virtual colonoscopy) every five years
-Yearly fecal occult blood test
Cervical cancer screening should begin at age 21, and women under age 21 should not be tested. Women aged 21 to 29 should have a Pap test every three years. Also available is the HPV test, but HPV testing should not be perferomed the 21-29 age group unless it is needed after an abnormal Pap test result.
Women aged 30 to 65 should have a Pap test plus an HPV test (called “co-testing”) every five years. This is the preferred approach, but it is also OK to have a Pap test alone every three years.
Women over 65 who have had regular cervical cancer testing with normal results should not be tested for cervical cancer. Once testing is stopped, it should not be started again. Women with a history of a serious cervical pre-cancer should continue to be tested for at least 20 years after that diagnosis, even if testing continues past age 65.
The American Cancer Society recommends that men make an informed decision with their doctor about whether to be tested for prostate cancer. Research has not yet proven that the potential benefits of testing outweigh the harms of testing and treatment.
