Cancer Testing In The Elderly: Does It Really Make A Difference?
Cancer testing in the elderly has recently become controversial. A growing number of cancer specialists, health system analysts, and geriatricians, are advocating for no testing. They insist, such testing is highly unlikely to detect lethal disease, hugely expensive, and more likely to harm than help. If lethal disease is found, follow-up testing and treatment is often invasive and comes with many debilitating side effects.
Cancer Testing: For The Elderly, Just Do It!
Doctors have a number of incentives to continue ordering cancer screening tests as people age.
- It’s a lot easier to order cancer screening tests than to tell the elderly patient that it’s not helpful when life expectancy is limited. Or to tell them that they won’t live long enough to benefit.
- Many physicians continue screening older people because they’re afraid they’ll be sued if they miss a cancer. Indeed, some health systems award bonuses to clinicians whose patients have high screening rates.
- It can be uncomfortable for a doctor to explain why doing less is more.
- Additional key reasons to test the elderly is their concern to prevent falls, treat depression, and alleviate stress. And, solutions do exist that can help them feel better very quickly for those conditions.
Cancer Testing: For The Elderly, Don’t Do It
There are several good and valid reasons not to screen elderly patients aged 70-90+.
Decades of public awareness campaigns have convinced patients that cancer screenings are essential. For example, many PR campaigns have convinced women that “mammograms save lives.”
But those campaigns don’t mention that doctors need to screen 1,000 women for a decade in order to prevent one death from breast cancer.
Yet screenings can have dire consequences. Medical complications during colonoscopies, such as intestinal tears, are almost twice as common in patients ages 75 to 79 compared with those 70 to 74, according to a study published in January in Annals of Internal Medicine.
Colonoscopies, which require extensive bowel cleansing before the procedure, also can leave many older people dehydrated and prone to fainting.
Next, prostate cancer tests can lead to prostate biopsies, in which doctors use needles to sample tissue, cause infections in about 6 percent of men. These infections send about 1 in 100 men who undergo the procedure to the hospital, according to a 2014 study in the Journal of Urology.
Even removing nonfatal skin cancers can cause problems for older patients, according to a study done by UC School of Medicine. Frail patients can struggle with post-op surgical wounds and change dressings. Their wounds are also less likely to heal well. More than 25% of patients with nonfatal skin cancers report a complication of treatment.
Cancer Testing: Complications For The Elderly
Screenings, follow-up tests and treatments can cause emotional trauma as well.
Among older women, about 70 percent report significant stress at the time of a biopsy. Simply lying on a table for a 45-minute biopsy can cause pain for women with significant arthritis.
Virtually all older women with breast cancer wind up getting surgery, which poses additional hardships. Hormonal therapies can cause bone pain, fatigue and increase the risk of stroke.
With prostate cancer, doctors offer men with early-stage disease “active surveillance” instead of immediate treatment. A study published last year in the New England Journal of Medicine found that men are just as likely to survive 10 years whether they choose to be treated or just monitored.
Among men who have had prostate cancer surgery, 14 percent lose control of their bladders according to a 2013 study in JAMA Internal Medicine.
In a study published in July in the Journal of Clinical Oncology, Richard Hoffman, MD, found 15 percent of prostate cancer survivors regretted their treatment decision. Those treated with surgery and radiation were twice as likely to regret their choice. In addition, Men are more likely to regret their prostate cancer treatment decisions if they don’t understand the risks beforehand.