Thursday, June 1, 2017

4 screenings called unnecessary; 2 others advised

Cancer screenings after 70 can do more harm than good, AARP magazine piece indicates

If you've hit 70 — when, according to my primary doc, "you've already won the game" — the need for some cancer screenings may vanish.

In fact, at least four of them might do more harm than good, indicates an article by Candy Sagon in a recent double edition of "AARP: The Magazine."

The unnecessary tests, the piece says, are colonoscopy, mammography, PSA and Pap smear.

In their place are recommended two other tests: bone density scan and abdominal aorta aneurysm screening.

The AARP magazine article charges that "a growing number of health experts [worry that] the overtesting of those who are in their 70s, 80s and even older…could lead to invasive procedures or treatments that leave patients worse off than before, especially among those with serious health problems such as heart disease."

Those fears may have been underscored by a 2014 study published in "JAMA Internal Medicine" that found — after looking at more than 27,00 adults age 65-plus — "too many physicians automatically recommend cancer screening tests for older patients whose precarious health puts them at high risk of dying within a decade."

Dr. Harlan Krumholz
The AARP article quotes Dr. Harlan Krumholz, a Yale cardiologist and researcher known to be an outspoken critic of overtesting, as saying, "On average, those over 75 derive fewer benefits than younger people do."

Women, the piece suggests, should be getting routine bone density scans "beginning at 65 (or earlier, depending on their risk factors)," while men 70 and older need that particular test "to check for osteoporosis."

Regarding the abdominal screening, the article says "men 65 to 75 who have been smoking anytime during their lifetimes should have a onetime ultrasound to screen for an abdominal aortic aneurysm (AAA)" — though the story hedges about whether the screening would benefit women who'd smoked.

As for the colonoscopies, it says a new Harvard study of "more than 1.3 million Medicare patients ages 70 to 79" found the risk of complications to be larger than the cancer risk. Obviously, however, "if you've had a polyp removed or have a family history of colon cancer, you risk is higher, and you should probably be screened. If not, you may be able to finally skip all that lovely laxative prep."

The AARP article cites the opinion of the U.S. Preventive Services Task Force when it comes to the mammograms. The USPSTF purportedly found "insufficient evidence" to conclude that mammography past 74 is necessary. It's likely, the agency indicated, that benefits of the screenings at that advanced age are limited.

Not a single medical group apparently recommends PSA screenings for prostate cancer beyond age 75 — even though 41 percent of men in that category still have the test (most often at the urging of their doctors).

If women have, after age 65, had no cancer or precancerous lesions, and have had three negative smears to check for cervical cancer in the previous 10 years, there's no need for one more smear. Unfortunately, the AARP story says at least one study indicates, "most women have become so accustomed to having an annual Pap smear that they have them even after undergoing a hysterectomy."

The benefits and burdens of screenings in general are addressed in "Rollercoaster: How a man can survive his partner's breast cancer," a VitalityPress book I, Woody Weingarten, aimed at male caregivers.

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