There is a long ongoing debate on whether the elderly need to be routinely screened for cancers. A new survey shows that the majority of nearly 19 million Americans over age 75 dutifully get screened for breast, prostate, and colon cancers each year.
The study, published in the Archives of Internal Medicine, examined data on more than 50,000 middle-aged and elderly adults, and found that 62% of women aged 75 to 79 had received a mammogram in the past two years, while 53% of women the same age had received a pap test for cervical cancer within the past three years. Among men aged 75 to 79, 56% were screened for prostate cancer. Overall, 57% of all adults aged 75 to 79 got colon cancer screens. The rates of screening dropped after age 80, but remained relatively high, with 50% of women getting mammograms and 38% receiving cervical cancer screens.
The study researchers have discussed the usefulness of such screenings. Dr. Locovico Balducci, a cancer expert at the Senior Adult Oncology Program at the Moffitt Cancer Center, told ABC News, “For breast cancer, colorectal cancer and cervical cancer — the cancers for which screening has been proved to be effective — if a person has less than five years to live, then screening is not beneficial. But if it's longer and if a patient can tolerate cancer treatment, they shouldn't be denied screening.”
With the percentage of people over age 65 expected to nearly double by 2050, it's important to weigh the health benefits of screening against the risks and costs of routine testing. The United States Preventive Services Task Force recommends against routine screening for breast, prostate and colon cancer after age 74, and advises against screening for cervical cancer in women aged 65 or older.
Especially these screenings can lead to additional biopsies and surgeries to remove cancer, which can cause side effects, while the cancers themselves may be slow-growing and may not pose serious health problems in patients' remaining years.
Dr. Keith Bellizzi, an assistant professor of human development and family studies at the University of Connecticut, lead researcher of the study, hopes that doctors will start to look more closely at screening efficacy — especially considering the explosion of elderly that will soon swell our population — and make more objective decisions about who will truly benefit from screening. “Over 50% of physicians are continuing to recommend screening tests in older men and women,” Bellizzi told Reuters. “I'm hopeful that these findings will serve as a catalyst for an important dialogue that needs to take place.”
Bellizzi suggests that instead of simply assuming that screening is always beneficial for every patient, doctors start with an assessment of whether the patient is likely, given his or her current health, to survive another five years. If they are, screening, detection and treatment of cancer could be justified.
Dr. Otis Brawley, chief medical officer at the American Cancer Society, told HealthDay that screening everyone over age 75 is a “waste,” noting, “Many docs are ordering these tests purely to cover themselves. We need to think about the rational use of health care and stop talking about the rationing of health care.”
In an accompanying editorial, Dr. Louise Walter, a geriatrician at the San Francisco VA Medical Center wrote that rather than debate about whether screening in older adults is right or wrong, the more important issue is whether patients are well informed about the benefits of screening and can make decisions based on that knowledge.
“While arguments persist about what is the 'right' rate of cancer screening in older persons, it seems clear that the rate of informed decision-making should approach 100 percent,” Walter wrote.
Yet another study showed that cancers are on the rise in the younger populations.
The study looked at nearly 600,000 colorectal cancer cases reported to a national registry between 1998 and 2007. As expected, cancer was much more common in the older age group. About 89% of the cases were seen in adults over age 50. But while colorectal cancer cases have dropped steadily in adults over 50, they increased by more than 2% each year in younger adults. The increase was highest for rectal cancers, which jumped nearly 4% each year. Colon cancer rates rose nearly 3% per year.
To compound the problem, doctors say many people may not suspect cancer when symptoms like bleeding, abdominal pain, or a change in bowel habits strike someone in their 30s or 40s. “Most young people, when they have these types of symptoms, they are not thinking that they have cancer. Then they go to their physician and the physician isn't thinking that they have cancer,” says Rebecca Siegel, MPH, an epidemiologist with the American Cancer Society in Atlanta. The result is often a delay in diagnosis.
The study found that younger adults were more likely than older adults to be diagnosed with late-stage cancers, which are harder to treat. People in their 30s were about 20% more likely than other age groups to be diagnosed when their cancers were stage III or IV, with stage IV being the most severe grade of the disease. Other factors that increased the risk for having an advanced cancer at diagnosis were being African-American or lacking health insurance.
“It's cause for concern,” says Siegel, who was not involved in the study. “And hopefully, it will spur additional research to try to identify what's causing this trend.” The study is published in the Archives of Internal Medicine.
Experts say the message to patients is clear, “Just because you're under 50 doesn't mean you're not at risk,” says Anthony Starpoli, a gastroenterologist at Lenox Hill Hospital in New York City. “If you have a family history, go talk to your doctor,” Starpoli tells WebMD, especially if that relative got colon cancer before they were 50.
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