Choosing Wisely: Cancer Screenings and Treatment for Older Adults

Cancer is the second leading cause of death for people age 65 and older, so your instinct may be to ask your doctor to order every type of cancer screening test available. But the latest recommendations from expert physicians say you should think twice before having a sometimes unnecessary – and potentially risky – diagnostic test.

Screening tests can certainly help doctors diagnose cancer early, when it’s more treatable. But when discussing screening for an older adult, both patient and physician need to have an individualized and realistic conversation about the risks and benefits of diagnosis and potential treatment.

What Are The Risks?

False Positives: Sometimes a screening test may incorrectly suggest that you have cancer, when you really do not. Your doctor may then end up running additional tests that are more physically invasive and more costly. The result can be unnecessary stress and worry, not to mention increased financial burden.

Complications: Always ask your doctor about possible complications from any screening, such as colon perforations during a colonoscopy. If your initial screening shows a false positive, you may be sent in for more invasive follow-up procedures, such as a needle biopsy or bronchoscopy to diagnose lung cancer, which have their own increased rate of complications.

Overdiagnosis: What if the worst-case scenario occurs and the screening and follow-up tests show a positive result for a cancerous or pre-cancerous nodule or polyp? It doesn’t necessarily mean your next step needs to be surgery, radiation or chemotherapy. Depending on the situation, sometimes the best course of action may be taking no action at all.

For example, low-grade prostate cancer is frequently slow-growing and slow to spread; it’s entirely possible that the patient may live the rest of their natural lifespan without suffering any adverse effects from the cancer. In fact, the side effects and risks involved with treatment may decrease their quality of life or even shorten their lifespan. For this reason, new research suggests its best for older adults with a life expectancy of less than 10 years to forgo many cancer screening tests.

Treatment Side Effects: If you are diagnosed with cancer, you should have a frank conversation with your doctor about the risks and side effects of treatment, as well as how long the treatment is actually expected to prolong your lifespan. Many older patients find that they prioritize quality over quantity of life – they find that the side effects, risk of severe infection, and extreme fatigue involved with chemotherapy are not worth the trade-off for a few additional months of life. For many patients, Palliative Care can help manage the symptoms of their disease without necessarily seeking a cure, allowing them to live a comfortable and fulfilling life with the people they love.

What Do The Experts Say?

The guidelines below, published by the American Academy of Family Physicians, gathers clinical recommendations from leading specialty cancer organizations about when different cancer screenings are typically considered no longer necessary:

• Breast Cancer Screening: Should not be performed in those with a life expectancy of less than 10 years.
• Prostate Cancer Screening: If performed at all, should stop at 69 years of age.
• Cervical Cancer Screening: May be stopped after age 65 if you have had negative screening results for the last ten years, or if you’ve had a hysterectomy that also removed your cervix.
• Colorectal Cancer Screening: Screening should only be done in patients between the ages of 76 to 85 if there is an increased risk, such as prior positive screenings or family history. Screening should not be performed in patients who are older than 85 years or have a life expectancy of less than 10 years.
• Lung Cancer Screening: Low-dose CT scans are recommended for patients between 55 to 80 years old who currently smoke or have quit within the past 15 years.

How To Decide?

The advice in this article is not meant to replace or supersede the advice of your doctor, but rather to encourage you to have a collaborative conversation with him or her about your health goals. One resource to help you with this dialogue is the Choosing Wisely website, developed by the American Board of Internal Medicine, which gives talking points on a wide range of conditions, tests, and treatments to help you advocate for yourself.

At the end of the day, remember that the choice is up to you. Any decision regarding your health care should be made after weighing the benefits and harms with your personal values and preferences. Your doctors and care team should be your partners in this decision-making process.