What cancer screenings should older adults get?
Industry Buzz
There are 55-year-olds who are functionally dependent [and] are at high risk for any screening... There are 80-year-olds that walk 2 miles a day and take only a multivitamin. I would be more likely to screen the 80-year-old in this case because their benefit is much higher and risk lower.
—Jessica Kalender-Rich, MD
Guidelines for cancer screenings in older adults vary between organizations. So what should you be recommending for your older patients when it comes to cancer screening?
“Older adult cancer screening should first be based on reviewing the risks and benefit of screening for each individual patient,” says Jessica Kalender-Rich, MD, Geriatric Medicine Specialist at The University of Kansas Health System. “Age is just a number and cannot be the only way we determine cancer screening recommendations. There are 55-year-olds who are functionally dependent, have significant comorbid conditions, and are at high risk for any screening, let alone subsequent treatment options for something that is found," Dr. Kalender-Rich says. "There are 80-year-olds that walk 2 miles a day and take only a multivitamin. I would be more likely to screen the 80-year-old in this case because their benefit is much higher and risk lower.”
At what point do you stop CRC screening in an 80-year-old with prior negative colonoscopies?
Cancer screening options
Generally, there are a few cancer screenings that should be considered for patients in the older population, Dr. Kalender-Rich explains. She highlights mammograms and discussions about prostate cancer screening for relevant patients, along with:
Colonoscopy and bone density screening for all people ages 65+
One-time abdominal aortic aneurysm screen for men who have smoked
Cervical cancer screening can typically end at 65, depending on risk factors
Screenings for STIs can continue depending on patient risk factors
Screening decisions should be individualized
While physicians must balance potential benefits with harms for patients, cancer screenings in this group are an important part of healthcare.
Related: USPSTF vs specialty societies: Where cancer screening guidelines clash in older adults“Since the incidence of cancers increases with the patient's age, screening tests become more important as a person ages. Essentially all the common cancers occur with increased frequency as the person ages,” Richard Reitherman, MD, PhD, board-certified radiologist and Medical Director of Breast Imaging at MemorialCare Breast Center at Orange Coast Medical Center in Fountain Valley, CA, tells MDLinx.
But Dr. Reitherman notes it is crucial for physicians to consider the needs of their individual patients.
“Recommendations for all cancer screening tests, including mammography, should be individualized and not determined by population statistics,” Dr. Reitherman says.
“This means that if a woman feels that she is healthy enough to have a screening mammogram and go through the process of potential treatment, the decision remains hers and hers alone. This in consultation with her physician should provide her best outcome,” he says.
“Screening mammography saves lives and reduces treatment morbidities at any age. Not having screening mammograms increases the risk of being diagnosed with more advanced breast cancer at any age. Most older women over the age of 70 diagnosed with breast cancer by screening mammography may have their cancer cured by outpatient surgery, no radiation, no chemotherapy, take a pill for 5 years and resume their productive lives.”
Related: When a patient presents with GI symptoms, here’s my approach: Considerations you can only learn in practice