Cancer Screening-Overused for Older Individuals

Cancer is one of the most frightening diseases out there. Many forms are difficult to treat, particularly if they are not caught early. The routine use of many screening tests to catch cancer in its early, more treatable phases over the last few decades has allowed many individuals to be cured before their disease progressed into its later stages. However, the overriding fear of cancer in public consciousness may have led to an unintended effect. Many older adults, long past the age when they should be receiving screening for some forms of cancer, are still receiving these tests on a regular basis. A recent report reveals that Medicare spent $1.9 billion between 2003 and 2008 on cancer screening for adults who were older than government recommended age guidelines for cancer screenings.


On the plus side, all this spending does create jobs that let people look at breasts all day.

Why do these age guidelines exist?
One of the reasons why cancer screenings eventually lose efficacy is that life is finite. Eventually heart disease, strokes, or other conditions are going to end it. If someone is ninety years old and has severe heart disease, they are going to be dead before a newly discovered case of prostate cancer becomes a problem. Cancer has become a rather potent fear in society so it's hard to just believe that letting it go on and grow is the best option, but sometimes it simply is. There's no reason to put a person with a host of other health problems through chemotherapy and surgery for a tumor that isn't going to cause any problems before the individual is likely to die.


Although it does give a good excuse for wearing a Hawaiian shirt.

Why are excessive screenings harmful?
There's a basic idea that more screenings and tests must be better than less. After all, if it can potentially locate something that can be treated early, why not do it? The problem with this thinking is that these tests and screenings are expensive and they are not always accurate.

Every screening test has the risk of false negatives and false positives. A false negative means that a case of cancer was missed by the test. A false positive means that a case of cancer was falsely identified as being present. A false negative means that cancer isn't being treated and may even result in early cancer symptoms being ignored because, hey, the screening last year didn't show any problems. A false positive is extremely frightening for a patient and may result in unnecessary biopsies and surgical procedures, which also pose their own risks.


Wait... it was benign?

An additional problem is that screening tests should also be shown to have some sort of benefit on survival of patients. For example, let's say there's a new screening test for metastatic pancreatic cancer. It detects it successfully 100% of the time. Unfortunately, there isn't anything at all that can really be done to treat metastatic pancreatic cancer, the median survival is between 6-10 months. At best, treatment will give a patient a couple months of extra life. This means that there is no point in using this screening test for the general population-it will not cause any improvements in survival and is thus just a waste of money.

It's actually pretty difficult to create screening tests that do not have too many false negatives or positives and are shown to improve survival rates for patients. Even some formerly routine tests are more controversial lately as research results have come back.

A good example is the Prostate-Specific Antigen test for prostate cancer in men. It used to be done routinely for men after age 50, but now the evidence reviewed by the United States Preventive Services Task Force suggests that Prostate-specific antigen–based screening results in small or no reduction in prostate cancer–specific mortality and is associated with harms related to subsequent evaluation and treatments, some of which may be unnecessary. Many physicians are still debating whether to continue performing the test or not, but it's certainly an example of a potentially gigantic waste of money.

Conclusion
Cancer screenings are a great tool to reduce cancer-associated mortality when they are used appropriately. However, they have become over-utilized in inappropriate groups of people, particularly the elderly. In many cases cancer may simply be able to be ignored in older adults because they are likely to die from something else first. As one example, many older men die WITH prostate cancer, but very few die FROM prostate cancer.

Perhaps the best way to view this information is to take a look at the overall health status of the person in question. If they are an extremely healthy eighty year old, maybe it's worth doing a screening because they may get a decade or more of life out of an early identification and treatment of cancer. If they have severe heart damage, Alzheimer's disease, and other problems, maybe it's a better idea to avoid doing the screening.