Questioning cancer screenings for seniors, part 2

As mentioned in my Part 1 article about “Questioning Senior Cancer Screenings,” the obvious lifestyle habits of maintainng a normal weight, exercising regularly, eating healthy, avoiding tobacco, limiting alcohol usage, and protecting one’s skin are important guidelines to follow to reduce the chance of developing cancer as a senior. Add this to the list: Know yourself and your family medical history, and have regular check-ups and cancer screenings. The problem these days is that the medical jury is still out on what screenings should be mandatory for our age, or what screenings are more dependent upon your inherited traits. If you are in your 70s or 80s, life expectancy also plays an important role in making your screening decisions. For example, Women’s Health Advisor (Weill Cornell Medical College) Newsletter (December 2014) tells us “A healthy 75 year old has an average of about 12 more years of life, while 85 year olds have about 7 more years.” Our newsletter continues by adding this info: “A recent study (JAMA Internal Medicine, October 2014) highlighted the fact that a substantial proportion of the U.S. population with a life expectancy of about nine years received prostate, breast, cervical, and colorectal cancer screenings that they were unlikely to benefit them (due to the length of time needed for their respective tumors to grow). Among the study participants who had the highest high mortality risk (and therefore, the shortest life expectancy), screening rates ranged from 31 percent for cervical cancer to 38 percent and 41 percent, respectively, for breast and colorectal cancer.”

We are also reminded by the women’s publication that “These guidelines assume your risk of cancer is average. Any cancer risk factors you do have should be factored into your decision, along with your overall health status.”

According to The American Cancer Society and Women’s Health Advisor (The U.S. Preventive Services Task Force), there are two tests recommended for men and women:

(1. Colorectal cancer and polyps. Beginning at age 50 and for most people between the ages of 50 and 75, the preferred test here is the colonoscopy, and it is usually good for 10 years. Other tests are also available; find out what your doctor recommends for you. If you are at high risk for colon cancer (such as a strong family history or a personal history of the polyps that can develop into tumors), your physician will determine what screening schedule will be best for you. If you are over the age of 75, the USPSTF recommends that you discuss further colon cancer screening with your doctor. The organization recommends against screening for colon cancer after age 85. (2. Lung cancer. This test is not recommended for people who are of average risk for this disease. The ACS and the USPSTF recommend an annual low-dose computed tomography (CT) screening for lung cancer in adults 55 to 74-80 years who satisfy all of the following: (1. In fairly good health; (2. Have a 30 pack-year smoking history (equivalent to one pack daily for 30 years or two packs daily for 15 years); (3. Are still smoking or have quit smoking in the past 15 years.

For men only: prostate cancer. ACS recommends that men, beginning at the age of 50, make an informed decision with their physician about whether to be tested for prostate cancer. Research has not yet proven that the potential benefits of testing outweigh the harms and risks of testing and treatment. However, if they are African American or have a father or brother who had prostate cancer before age 65, men should discuss the situation starting at age 45. If men decide to be tested, the PSA blood test with or without a rectal exam is used for screening. How often they are tested will be determined by their blood level.

For women only: (1. Breast cancer. The USPSTF recommends that women between the ages of 50 and 74 have a mammogram every two years. They also conclude that the evidence is insufficient to assess the benefits and harms of screening mammograms in women age 75 and older. However, the AMS recommends an annual screening as long as a woman is in good health. The American Cancer Society tells us “The harms and benefits of screening should be weighed on a personalized basis, taking remaining life expectancy, cancer risk, functional status, and patients’ preferences into account.” WEB MD tells us that breast screenings are now being studied in research for older women. (2. Cervical cancer screening. Current screening guidelines state that, after the age of 65, Pap testing along with HPV testing (co-testing) should take place every 5 years; Pap testing alone should take place every 3 years. Current screening guidelines state that, after the age of 65, women can stop having routine Pap tests if they have had normal findings on three previous consecutive Paps in the last 10 years. Testing should not be started again. Women who have a high risk of cervical cancer, (those already having had cervical cancer, now smoking, or having begun sexual activity at an early age, etc.), might be advised by their physician to continue having testing done after the age of 65. (3. Uterine cancer. The ACS recommends that at the time of menopause, all women should be told about the risks and symptoms of uterine cancer. Women should report any unexpected bleeding or spotting to their doctors. Some women, because of their history, may need to consider having a yearly endometrial biopsy. They should talk to their doctor about their history. (4. Ovarian cancer. Screenings for ovarian cancer result in many false positives and have little impact on mortality rates. It is only recommended for women who have a strong family history of ovarian cancer or a known breast or ovarian cancer gene mutation. In addition, the CA 125 blood test used to screen this cancer has limited accuracy, so it’s not always possible to get a definitive answer with testing.

In addition to these tests, health exams with a cancer-related check-up is advised. These physician-directed exams search for cancers of the thyroid gland, the oral cavity (mouth), skin, lymph nodes, and sexual organs. For questions on this subject, call the American Cancer Society at 1-800-227-2345 or visit www.cancer.org.

---

---