Cancer Screenings: Which Ones You Need and How Often You Need Them
Cancer remains the second most common cause of mortality in the U.S., accounting for nearly one in every four deaths. According to the American Cancer Society, in 2014, an estimated 1,665,540 new cancer cases will be diagnosed, and 585,720 cancer deaths will occur in the U.S.
You can lower your risks with lifestyle measures that help prevent cancer by eating a healthy diet, getting regular exercise, maintaining a normal weight, and avoiding tobacco. However, you can’t avoid two of the main risk factors for cancer—age, and having a family history of the disease. This is where cancer screening enters the picture.
Screening tests have become a vital part of cancer prevention and treatment. That said, many experts are now questioning whether the benefits of screening have been oversold, particularly where older adults are concerned.
Life Expectancy is Key
It can be difficult to assess your own life expectancy, but it should be one of the factors you consider in your screening decisions. Statistics can help you; as an example, a healthy 75-year-old has an average of about 12 more years of life, while 85-year-olds have about seven more years.
“Even so, there is still great variability, depending on your health status and functional ability,” notes Elizabeth Leef Jacobson, MD. “As a rule, an 80-year-old woman who is in good physical and mental health, exercises regularly, and eats healthfully has a longer life expectancy than a woman the same age who has several chronic health conditions, leads a sedentary life, and eats a poor diet. Consequently, the second woman may not benefit from continuing routine cancer screening tests.”
Advances in knowledge
“Decades ago, it was believed that cancer’s spread and progression was aggressive and inevitable, and that a cancer diagnosis was a death sentence. But now, we have a more sophisticated understanding of how cancer works,” says Elizabeth Leef Jacobson, MD, assistant professor of medicine at Weill Cornell Medical College. “We know that it behaves in different ways, depending on where in the body it occurs. We also know that some types are more aggressive, and some are slow to develop and spread.”
That knowledge suggests that it may not be as important to routinely check for slow-growing cancers in older adults. “For example, it takes about 10 years for a polyp to develop into colorectal cancer,” Dr. Jacobsen notes. “So, screening for this cancer after about age 85 won’t result in an improve-ment in your health, since any cancer found likely wouldn’t cause symptoms during your remaining life-time.” She adds that the risk of complications during a colonoscopy, such as bleeding or a perforated bowel, is higher in frail seniors.
Screening also can lead to false positive results. “An abnormal mammogram may be a false positive, which can lead to anxiety and unnecessary testing,” Dr. Jacobsen says. “Beyond these factors, if a cancer is found, treatment may cause serious side effects and detract from your quality of life, and you may not live long enough for it to have a lasting positive outcome.”
Too much testing?
A recent study (JAMA Internal Medicine, October 2014) highlighted the fact that a substantial proportion of the U.S. population with a life expectancy of about nine years received prostate, breast, cervical, and colorectal cancer screenings that were unlikely to benefit them. Among the study participants who had the highest high mortality risk (and therefore, the shortest life expectancy), screening rates ranged from 31 percent for cervical cancer to 38 percent and 41 percent, respectively, for breast and colorectal cancer.
Various recommendations have been established to help guide you and your doctors in determining if a test is likely to be beneficial.
“Keep in mind that these guidelines assume your risk of cancer is average,” Dr. Jacobson says. “Any cancer risk factors you do have should be factored into your decision, along with your overall health status.”
A guide to cancer screenings
Here is the basic information you need to know about cancer screenings that are advised for women who are age 50 and older.
Breast cancer. The U.S. Preventive Services Task Force (USPSTF) recommends that women between ages 50 and 74 get a mammogram every two years. The USPSTF also concludes that the evidence is insufficient to assess the benefits and harms of screening mammography in women age 75 and old-er.
However, the American Cancer Society recommends annual screening, and, for those women who wish to have them, annual mammograms will continue to be covered as a preventive care service under the Affordable Care Act and by Medicare.
Colorectal cancer. Most people should have a colonoscopy every 10 years between ages 50 and 75. If you are at high risk for colon cancer (for example, if you have a personal or family history of colon cancer, or a personal history of the polyps that can develop into tumors), your doctor may advise more frequent screening.
If you are over age 75, the USPSTF recommends that you discuss further colon cancer screening with your doctor. It recommends against screening for colon cancer after age 85.
Cervical cancer. Current screening guidelines state that you can stop having rou-tine Pap tests at age 65 as long as you’ve had normal findings on three previous consecutive Paps during the last 10 years. You also don’t need to have Paps if you’ve had a hysterectomy in which the cervix was removed.
However, if you are high risk for cervical cancer (for example, if you or your partner have had a large num-ber of sexual partners, if you started having sex at a particularly young age, if you smoke, or if you’ve already had cervical cancer), your doctor may recommend that you continue having Paps beyond age 65.
Ovarian cancer. Screening for ovarian cancer results in many false positives and has little impact on mortality rates, so it is only recommended for women who have a strong family history of ovarian cancer or a known breast or ovarian cancer gene mutation. In addition, the CA125 blood test used to screen for ovarian cancer has limited accuracy, so it’s not always possible to get a definitive answer with testing.
Lung cancer. The USPSTF recommends annual low-dose computed tomography (CT) screening for lung cancer in adults ages 55 to 80 years who have a 30 pack-year smoking history (equiva-lent to one pack a day for 30 years, or two packs a day for 15 years), or who currently smoke or have quit within the past 15 years.
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