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Should older adults undergo routine cancer screening? Many do, despite known benefits

Kathleen Blanchard's picture
Study finds older adults over 75 undergo cancer screening with unknown benefits.

(EmaxHealth) Researchers find older adults over age 75 are still receiving routine cancer screening tests that aren’t recommended by the U.S. Preventive Services Task Force.

The finding, published in the Archives of Internal Medicine, showed cancer screening is even high in the 80 year old group, despite evidence that testing is beneficial and may lead to more harm than good.

But lead author of the study, Keith Bellizzi, an assistant professor of human development and family studies at the University of Connecticut in Storrs, says the reasons cancer screening is common among older adults isn’t entirely clear.

Fifty percent of men and women over age 75 said they had their colonoscopy or other test to detect cancer just because the doctor recommended it.

For their study, the researchers analyzed data from the National Health Interview Survey to discover 62% of women aged 75 to 79 years and half of women aged 80 years and older reported getting a mammogram within the last 2 years.

The data also showed a high number of women age 75 and even over 80 still get their PAP (cervical) smears.

Seventy- five percent of men in the 75 to 79 age group had a fecal occult blood test (FOBT), sigmoidoscopy or colonoscopy within the preceding two years.

"Historically older adults have been excluded from screening trials, so the screening efficacy data in this population are really limited," said Bellizzi.

He says the concern is about overdiagnosis that could lead to unnecessary tests, like biopsies. Another is that older adults are more likely to be sick and unable to tolerate the treatment if a diagnosis of cancer is made.

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Half of physicians continue to recommend cancer screening for older adults, Bellizzi says.

He says there hasn’t been enough attention paid on how to separate older adults who should be screened for cancer from those who might be harmed.

In an accompanying editorial, Louise C. Walter, MD, from the Division of Geriatrics, University of California, San Francisco, and San Francisco Veterans Affairs Medical Center said people are living longer; a factor that might make cancer screening beneficial for older seniors.

The study didn’t take into account the overall health status of the participants, whose overall health and expected -*lifespan was unknown.

Educated seniors were more likely to have been screened for cancer. Studies have shown higher socioeconomic status and education is associated with better health, which may account for the high numbers of older adults screened for cancer; found in the study.

The best advice for seniors is to have open dialogue about the risks and benefits of cancer screening. "I would recommend for patients to have a real thoughtful conversation with their provider to talk about the potential harms…”, Bellizzi said.

The authors say until now not much was known about cancer screening behaviors in the older population.

The risks include unnecessary treatment from overdiagnosis for seniors who may suffer complications and couldn’t withstand cancer treatment. But if you’re a healthy, active senior, the benefits could outweigh the risks of cancer screening and treatment.

Arch Intern Med. 2011;171(22):2031-2037.
doi:10.1001/archinternmed.2011.570: Abstract

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The medical community, led by FDA, should come up with clear guidelines on older patient cancer screening. Otherwise some doctors reccomend screening while others don't. Imagine how much resource is wasted now and harm done.
Exactly Janis.
There was an interesting article a while back at the Health Journal Club that talked about how the usefulness of a diagnostic test changes depending on how many people in the population have the disease to start with. That is to say if most people are healthy to start with the test is most often wrong in this larger group of healthy people. It is a bit of an eye opener to see how quickly the usefulness of a screening test can change depending on how many people have the disease to start with.