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Screening tests for women after age 75

If you’re a woman close to age 75, you may have followed the same schedule for mammograms, Pap smears, and other screening tests for decades. So you may be surprised that your physician is suggesting fewer tests or longer intervals between them. The risk for many degenerative diseases increases with age, so shouldn’t older women be monitored even more closely? The answer is, “It depends on the woman.”

By age 75, there’s a growing disparity in “biological” age among women of the same chronological age. At age 75, 25% of women live an average of 6.8 more years, 50% live an average of 11.9 more years, and 25% live an average of 17 more years.

In general, the more chronic conditions a woman has, the shorter her life expectancy. A woman who has fewer years left and is focused on her overall function may not benefit from detecting a slow-growing cancer that’s unlikely to affect the length or quality of her life, while another woman who has a longer life expectancy probably would.

Screening guidelines

Screening tests are examinations aimed at detecting disease before symptoms develop. By detecting disease before it becomes apparent, clinicians are usually able to treat it more effectively — and often cure it.

The United States Preventive Services Task Force (USPSTF), an independent panel of primary care clinicians established by the U.S. Congress, is responsible for developing federal guidelines for all screening tests .

USPSTF screening guidelines for women ages 50 and over

Breast cancer

Mammogram every two years, to age 74.

Cervical cancer

Pap smear every one to three years, to age 65.*

Colorectal cancer

Screening by fecal occult blood testing, sigmoidoscopy, or colonoscopy, to age 75.

Hearing loss

No recommendation.

High blood pressure

Blood pressure measurement at unspecified intervals.

High cholesterol

Lipid test at unspecified intervals in women with one or more heart disease risk factors.**

Osteoporosis

Bone density testing with dual energy x-ray absorptiometry (DXA) at unspecified intervals in women ages 65 and over.+

Vision loss

No recommendation.

*Screening may stop in women over age 65 who have had “adequate recent screenings” and are not at high risk for cervical cancer.

**Diabetes, previous heart disease, family history of cardiovascular disease before age 60 in female relatives, tobacco use, high blood pressure, and obesity (body mass index of 30 or higher).

+Screening can start at age 60 in women at increased risk for osteoporotic fractures, although the exact risk factors that should trigger screening are not clearly defined.

Source: Guide to Clinical Preventive Services, 2010–2011: Recommendations of the U.S. Preventive Services Task Force, available online at www.ahrq.gov/clinic/pocketgd.htm.

What the guidelines don’t say

The USPSTF has found that there isn’t enough evidence to recommend screening women over age 75 for certain diseases, particularly breast cancer, cervical cancer, and colorectal cancer. That doesn’t necessarily mean the screening tests aren’t effective. In many cases, there just weren’t enough older people in the studies to permit a judgment for or against screening.

It’s important to understand that most screening guidelines are developed for the maximum benefit of a whole population rather than the individual. They aren’t designed to consider each woman’s unique family history, state of health, and risk factors. You and your clinician can work together to develop a screening schedule that’s appropriate for you.

Tests likely to benefit most women

The USPSTF and other medical organizations recommend some screening tests with no age limits. These tests, listed below, offer substantial potential benefits, pose little or no risk, and are covered by Medicare:

Blood pressure measurement. This risk-free test identifies hypertension, a highly treatable condition that affects 58% of women over age 65 and is a major risk factor for both heart disease and stroke.

Serum lipid profile. This blood test measures total cholesterol, HDL (good) cholesterol, and LDL (bad) cholesterol. It’s important for calculating your risk of a heart attack or stroke and essential for anyone at risk for coronary disease, the top killer of women over age 65..

Bone density measurement. The gold-standard bone-density test, dual energy x-ray absorptiometry (DXA), is noninvasive, uses minimal radiation, and takes about 20 minutes. The results are evaluated and the Fracture Risk Assessment (FRAX) tool may be used to predict your risk of a fracture in the next 10 years. If your FRAX score indicates a high risk, you and your clinician can discuss your options.

Tests to discuss with your clinician

The tests below aren’t recommended by the USPSTF for women over age 75. If your clinician recommends any of these tests, Medicare will cover the cost:

Mammography. Mammography itself poses few risks for a woman over age 75, so the main issue is how much treatment you would be willing to undergo should breast cancer be discovered.

Colonoscopy. This test allows a clinician to look at the lining of the entire colon and remove polyps (growths that can sometimes become cancerous). It’s the only screening test that can actually prevent cancer. The USPSTF doesn’t recommend any colon cancer screening after age 75. If you’ve had a precancerous polyp removed or have a family history of colon cancer, your risk of cancer is higher and the test may be recommended.

Pap smear. The USPSTF recommends against screening women over age 65 who have had normal Pap smears in “adequate recent screenings” and aren’t otherwise at high risk for cervical cancer.

January 2012 Update

 

A Guide to Women's Health: Fifty and forward

Midlife can be a woman’s halftime celebration. Not only can it be an opportunity to reflect on and rejoice in the life you’ve lived, but it is also a good time to plan your strategy for the future. This report will help you determine the conditions for which you are at greatest risk and do your best to avoid them. It will also help you to better manage chronic conditions that may erode your quality of life, and to deal with physical changes that are more bothersome than serious. It is... Learn more »