Health Screenings in the Elderly
If you’re caring for a parent or a loved one, chances are you’ll have to make a lot of difficult decisions. Or, there may be times when a doctor recommends something that you might not understand. For example, your loved one’s physician may say it’s time to stop screening for certain diseases. You may ask “why?”
First, it’s important to take a look at the top diseases and conditions for which the elderly are screened.
According to Dr. John Russell, Director of the Family Medicine Residency Program at Abington Memorial Hospital, the number one cause of death is related to cardiovascular disease. As a result, people are screened for conditions that may increase the risk of it. “Elderly folks and the adult population are screened for diabetes, high blood pressure, and high cholesterol,” he said.
Since the risk for cancer increases with age, Dr. Russell says seniors should also receive screening exams for appropriate cancers, but it’s not always the same for everyone. “Every screening test should take into account the patient’s other medical conditions, interests, and preferences; everything should be individualized to the particular patient,” Dr. Russell said.
When discussing if screenings should cease, it’s important to take current life expectancy into consideration. Today, a 65-year old man can expect to live another 17 years, while women at the same age can look forward to an extra 20 years. Additionally, there are certain governing organizations that provide doctors with recommendations on how to instruct patients.
“Patients have the ability to take that advice or not, or a physician might realize someone has a significant heart condition and that screening for cancer doesn’t make sense, since it won’t necessarily make them live longer,” said Dr. Russell. “The point of any screening is to detect cancer in an asymptomatic state and treat it to make someone live longer.” In some cases, however, screenings aren’t necessary if there’s a known condition that may be fatal.
For cancers that do have recommended ages for screenings, Dr. Russell looks to the governing organizations to determine when screening should stop. These include screenings for:
- Breast Cancer: Since there is not much evidence that breast cancer screening in women over the age of 70 dramatically increases their lifespans, there is a wide variety of recommendations from governing bodies. The U.S. Preventive Services Task Force (USPSTF) recommends screening stop at age 75. The American Cancer Society (ACS) doesn’t provide an age recommendation, but says mammograms should continue as long as a woman is in good health. The American Geriatrics Society (AGS) says routine screenings should continue for women 85 and younger with a life expectancy of at least five years.
- Cervical Cancer: If a woman has had a hysterectomy for benign reasons, she no longer needs a pap smear. For women who have not, the USPSTF recommends screenings stop at age 65 if the patient has had adequate recent screenings with normal pap smears and is otherwise not at high risk. The AGS recommends stopping at age 70 if the patient had regular screenings prior to this one. ACS recommends stopping at 65 if the woman has had three or more normal results in a row and no abnormals in the past 10 years.
- Colon Cancer: The USPSTF recommends routine screening only until age 75. The AGS says to stop if the life expectancy is less than three to five years. The American College of Physicians (ACP) recommends stopping at age 75. The ACS has not yet determined recommendations on when to stop screening.
- Prostate Cancer: Since screenings for prostate cancer have been under scrutiny due to controversy over the use of PSAs, many organizations differ in their recommendations. The USPSTF advises not to screen anyone, while the AGS says it’s difficult to justify screening in men over 70. The American Nurses Association (ANA) recommends PSA screening in men 55-69 years of age; however the decision to do so should be made by both the physician and patient.
- Lung Cancer: The guideline that’s currently accepted by all governing bodies says that people should be screened for lung cancer yearly for three years if they’re between the ages of 55 and 75 with no history of cancer. They should also have quit less than 15 years ago and have 30 pack years of smoking (two packs per day for five years or one pack per day for 30 years.)
If you have any more questions about when to stop screening in the elderly, be sure to ask your physician.