Cancer Tests for Seniors: Are They Always Recommended?

The April 2016 research letter Prevalence of Non-Recommended Screening for Prostate Cancer & Breast Cancer in the U.S.: A Nationwide Survey Analysis that is published on the JAMA Network states that nearly 20 percent of individuals aged 65 years or older are still receiving preventative screenings for prostate or breast cancer, despite the fact that these preventative tests are not necessarily recommended for individuals within this age group. These recommendations are in place because the patients within this age group are not expected to survive the length of time necessary to receive benefits from the treatments; furthermore, for those seniors who are not expected to live more than 10 years, the cancer found through a screening will probably not grow quickly enough to cause his or her death before another condition does (e.g., diabetes or heart disease).

Unnecessary Screening Programs May Cause Harm

Dr. Firas Abdollah of Detroit’s Henry Ford Hospital (and lead author on the aforementioned study) states that the treatment of tumors while they are in the early-stages may reduce the likelihood of cancer mortality; however, despite this possible benefit, cancer screening programs can be harmful. The JAMA report states that some seniors with a relatively short lifespan are over-diagnosed and over-treated, potentially leading to significant mental and physical health problems.

Data from Nearly 150,000 Seniors Reviewed

In order to assess the frequency of unnecessary cancer screenings for individuals aged 65 and older, researchers reviewed data collected from 150,000 surveys that were completed in 2012. Approximately 50 percent of all the individuals surveyed report that they had either had a mammogram or PSA test to detect cancer. In reference to the seniors who were screened, around 30 percent had a life expectancy of less than 10 years.

The U.S. Preventative Services Task Force’s Recommendations for PSA Tests

Since 2012, the independent U.S. Preventative Services Task Force has stated that there is moderate certainty the benefits of PSA-based screening do not overshadow the harms. Moreover, the task force does not recommend PSA-screening for men of any age as studies indicate that screening for prostate cancer only minimally reduces an individual’s risk of death, if at all.

Reasons Physicians Still Order Preventative Screening Tests for Seniors

David A. Asch is the executive director of the Center for Health Care Innovation. He is also a professor at the University of Pennsylvania. Peter A. Ubel is a professor at North Carolina’s Duke University. Ubel and Asch recently provided psychological explanations as to why it is difficult for physicians to let go of old practices, even if there is new evidence revealing that these practices offer little value to the patient. Ubel and Asch argue that a physician’s preconceptions may cause him or her to scrutinize studies offering evidence that goes against their initial beliefs. Furthermore, physicians are likely to remember rare events, such as a young patient dying of advanced breast cancer because she neglected to receive her mammogram screening.

The American Cancer Society’s Recommendations for Seniors

Men and Women

Men and women aged 65 and older need to speak with their physician regarding screenings for:

• Lung Cancer – Individuals who actively smoke or quit smoking within the past 15 years, do not display any signs of lung cancer and have a 30 pack a year smoking history (this refers to smoking one pack of cigarettes per day/per year for 30 years or two packs per day/per year for 15 years) should ask about a low-dose CT scan to screen for lung cancer.
• Colon Cancer – Some form of colon cancer testing is recommended.

Men

Men who are 65 years and older should speak with their physician about whether they need to be tested for prostate cancer or not.

The American Cancer Society has set forth the following guidelines:

• Prostate Cancer – The decision as to whether prostate cancer testing is necessary should be based on a patient’s overall health. The American Cancer Society also states that men who expect to live at least 10 more years should speak with their health care provider about the risks, uncertainties and possible benefits of preventative testing for prostate cancer.

Women

Women who are 65 years and older should speak with their physician about which cancer tests he or she would recommend.

The American Cancer Society has set forth the following guidelines:

• Cervical Cancer – Women aged 65 and older who have had regular cervical cancer testing with normal results consecutively for 10 years do not need to continue having preventative cervical cancer testing. Furthermore, no testing is necessary for women who have had a hysterectomy that involved the removal of the cervix and uterus as long as the hysterectomy was not performed due to cervical cancer. Women who have a pap-smear history that resulted in pre-cancerous cervical cells should continue testing for 20 consecutive years following that diagnosis.
• Breast Cancer – Senior women should continue to report any changes in the way their breasts look and/or feel. While the American Cancer Society recommends that women receive a mammogram bi-annually, some women do request annual mammograms; however, the society encourages women 65 years and older to explore the pros and cons of continued preventative breast cancer screening. That said, women who have risk factors that increase their chances of breast cancer should speak with their health care provider about which tests they should have in conjunction with a mammogram.

Screening is Recommended for Seniors with Symptoms

Dr. Therese Bevers is the cancer prevention center ‘s medical director at the University of Houston MD Anderson Cancer Center, she was not involved in the Prevalence of Non-Recommended Screening for Prostate Cancer & Breast Cancer in the U.S.: A Nationwide Survey Analysis study; however, Bevers states that the recommendations related to avoiding cancer screening for seniors should only apply to those individuals without current symptoms or a prior cancer diagnosis. She continues, stating that a man having difficulty urinating or ejaculating and a female who examines her breast, and finds a lump may benefit from cancer screening tests. Cases such as these are not considered preventative screenings, but diagnostic tests.