Howard LeWine, M.D.

Many seniors get unnecessary and potentially harmful cancer tests

Screening is an important part of routine medical care. Screening means checking a seemingly healthy person for signs of hidden disease. It is routinely done for various types of cancer, heart disease, diabetes, and other chronic conditions.

Common cancer screening tests include:

  • mammogram for breast cancer
  • PSA test for prostate cancer
  • colonoscopy for colon cancer
  • Pap smear for cervical cancer

Screening makes sense when finding and treating a hidden condition will prevent premature death or burdensome symptoms. But it doesn’t make sense when it can’t do either. That’s why experts recommend stopping screening in older individuals, especially those who aren’t likely to live another five or 10 years.

Yet an article published online in JAMA Internal Medicine shows that many doctors still recommend cancer screening tests for their older patients. Many don’t benefit, and some are even harmed by the practice.

A team from the University of North Carolina, Chapel Hill, looked at cancer screening tests among 27,000 men and women over age 65 who took part in the National Health Interview Survey. They also ranked the participants by risk of dying in the next nine years based on their health.

Among individuals with the highest risk of dying within nine years, many had undergone cancer screening in the two years before the interview. More than half of the men in this group had a PSA test to check for hidden prostate cancer. The screening rates were 41% for colorectal cancer, 37% for breast cancer, and 31% for cervical cancer.

Smarter screening decisionmaking

These findings are troubling. Asking people who can’t benefit from a cancer screening test to have one is a waste of their time and money, not to mention a waste of taxpayer money (since these tests are usually covered by Medicare). Screening tests can also cause physical and mental harm. A colonoscopy can tear the lining of the colon, potentially causing a serious infection.

A high PSA test often sends men to undergo expensive biopsies. These can cause infection and pain. And if prostate cancer is found, many men will opt for treatment with surgery or radiation therapy even though the slow-growing cancer would not have shortened their lives. Mammograms don’t usually cause problems, but many lead to biopsies that show no cancer present.

Medical societies and other expert groups recommend the following:

  • Stop routine Pap smears to screen for cervical cancer at age 65 if Pap smears have been negative in the past.
  • Stop routine screening mammography for women at average risk of breast cancer after age 75.
  • Stop screening colonoscopies for adults at average risk of colorectal cancer at age 75.
  • Stop routine screening with PSA for men at average risk of prostate cancer, independent of age.

Unfortunately, many doctors ignore these guidelines. Why? Experts realize that cancer screening recommendations based on age alone are too arbitrary. A frail 75-year-old with heart disease and diabetes is different from a robust 75-year-old who exercises every day. So many experts suggest considering a person’s life expectancy. If it is less than 10 years, cancer screening is unlikely to improve a person’s survival or quality of life, and the risks of screening are greater than the benefits.

But estimating life expectancy is very difficult. So doctors are reluctant to make what amount to a guess for many of their patients.

That’s why a decision about cancer screening should be mutually made by an individual and his or her doctor. Equally important, the person should be well informed about the risks of the test and about what will happen if a test suggests there may be cancer that won’t shorten the his or her life.

At the same time, all of us should be focusing more on preventing cancer in the first place, rather than trying to detect it later. The best ways to do this include:

  • staying physically active and spending at least 150 minutes per week on moderate intensity exercise
  • maintaining a healthy weight
  • not smoking or using other tobacco products
  • avoiding alcohol or drinking moderately (no more than one alcoholic beverage a day for women, no more than two a day for men)
  • eating a diet rich in fruits, vegetables, and whole grains.

Related Information: A Plan for Successful Aging

Comments:

  1. Dr Puneet Chandna

    Over-diagnosis and unnecessary testing could just be due to a shot gun approach that many clinicians follow in their daily practice.

  2. A-1 Domestic

    The purpose of screening is prevention. Doctors should only recommend, but if patients refuse, they should not be scared into doing it nor should doctors insist until they bend their patients’ will.

  3. Scott

    Also, seniors have to make sure they tell their doctors if they are taking PSA lowering medications such as Flomax, Finasteride or Avodart when they get a blood test or prostate cancer screening. These medications can affect PSA test results.

  4. skin tightening

    Very very nice post.I am agree with this post.The seniors has more experience.But sometimes people scary to test screening cancer, they afraid of the result if the result is unwanted.Thanks a lot for sharing this post.

  5. Wounded Warrior

    I think it goes beyond seniors, it’s an epedemic in America and the direct outcome of technology in the medical field. Our orthodox medicine is broken, we over treat with expensive procedures because doctors get paid extra to push these machines on patients. The entire system is broken and it starts with our government being controlled by corporations.

    As an architect I’ve done a major research project on medical facilities and why American health is so poor, all I have to say is follow the money. And look at the pharmecutical companies. We are the only country who allows pharmecutical company’s to advertise to the general population. We are a dependent society folks

  6. Vince Miraglia

    Is it surprising that a revenue stream that benefits providers is overused. Physicians see great profit in $ceening test greatly overestimate benefit : consistently minimize damage caused …perhaps in future post you can address such well thought out ideas as beta blockers before surgery…Really about a large amount of the medical cost is for ……..

  7. Betty Sherman

    My mother developed breast cancer at 80, was treated and lived happily to 93. My doctor agrees that at 81 I should continue mammograms every two years. I am healthy, excercise and eat sensibly. I lead a full active life and that is due to a knee replacement I had 3 years ago.

  8. NotWorldly

    C Hendershott (Aug. 21) tells it like it is; the bureaucrats think old people should suffer and die, and that they don’t deserve a decent quality of life just because they are elderly.

  9. C Hendershott

    Well, of course if you don’t test people (and old folks are still people…), there will be fewer diagnoses and fewer treatments –expensive or cheap. Want to save money from grammy’s estate, keep her away from all doctors, tests, and treatments. Wouldn’t want her to enjoy her old age by having her knees replaced…. She would only use them for ten years anyway.
    Never mind that older people are living independently and well for more years as time goes on. Cut off treatment at 65 anyway. The bureaucrats and bean counters love it.

    Don’t want a baby that is going to need time and attention? Have an abortion…..fast, convenient, efficient. Got a mother or grandmother that is inconvenient? Take away medical care now or pass a rule against looking for health problems that are treatable. If you don’t look, you won’t find any. Problem solved.
    Just remember, someday, if you are lucky, you too may live long enough to enjoy a long life.

  10. Ms Gael

    My 89-year-old mother-in-law had a mammogram at the insistance of her doctor. I think this is almost malpractice.

  11. fernin c miranda

    great!!!

  12. Rahmania Farid

    But sometimes people scary to test screening cancer, they afraid of the result if the result is unwanted.

  13. Sam Miller

    Unfortunately, it isn’t just “senior” members that often get unnecessary cancer screening tests. It’s a general occurrence, mostly because of significant overdiagnosis. As long as the reigning theories of cancer development are steeped heavily in medical dogma instead of sound science (discussed in Rolf Hefti’s “The Mammogram Myth”), this trend of harm infliction continues unabated.