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One Size Doesn't Fit All When it Comes to Cancer Screening.

We're looking at mammography in this month's issue, and specifically at its use in women age 75 and older. It's a topic that often is raised by my patients, many of whom are unsure whether the test remains advisable once they reach their seventies. In fact, screening for older adults has come under the microscope in the last decade, with the U.S. Preventive Services Task Force (USPSTF) issuing recommendations for several cancers. The recommendations apply to healthy people at average risk, who don't have symptoms. They are based on a realistic appraisal of how likely older adults are to benefit from finding out they have cancer, and whether they are likely to live long enough for treatment to have a positive outcome.

These guidelines don't imply that older age means your life has less worth than that of a younger adult. What they do reflect is that cancer screening aims to identify disease many years before it begins to affect a person's health. It follows that screening the oldest old for cancer may not result in an improvement in their health if the cancer likely won't cause symptoms during their remaining lifetime.

Colorectal cancer is one such slow-growing cancer. Colonoscopy is a screening test I recommend to healthy older adults, but the "bowel prep" needed before the procedure is unpleasant (see our article on page 6 for tips on managing bowel prep), particularly for frail elders.

It involves taking laxatives that cause diarrhea and occasionally dehydration and/ or electrolyte disturbances that can result in weakness, nausea, and confusion. There also is a slight risk of complications from the test itself (such as bleeding, or a perforated bowel). Given that it takes about 10 years for a polyp identified on colonoscopy to develop into a tumor, you might want to discuss with your doctor whether you should stop having a routine colonoscopy once you pass age 75.

Where breast cancer is concerned, no upper age limit has been set for mammography. The risk of developing breast cancer increases with age--however, as with colorectal cancer, the question is whether cancers detected by mammography will progress to affect a woman's quality and length of life, and whether treatment would be beneficial.

Screening recommendations are not "one-size-fits-all"--there is science behind them that tries to provide you with greater benefit than risk from the tests. So, if you are weighing whether to continue routine mammography, have a candid discussion with your doctor about whether you are likely to benefit from breast cancer treatment if you are diagnosed with the disease. And keep in mind that even if you decide to forgo further breast cancer screening, there are still multiple ways that you can be proactive about preserving your health and function as you age.

Rosanne M. Leipzig, MD, PhD


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Title Annotation:FROM THE EDITOR
Author:Leipzig, Rosanne M.
Publication:Focus on Healthy Aging
Article Type:Editorial
Geographic Code:1USA
Date:Mar 1, 2019
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