Most doctors agree that it doesn't make sense to haul a frail, elderly person out of a nursing-home bed for a mammogram or other diagnostic test. And doctors generally agree that if a patient has a limited life expectancy because of a "competing illness," there's little point to looking for cancer and treating it if it is found.
But what about healthy seniors who still work or are enjoying their retirement years? If 70 is the new 50, how old is too old for cancer testing and treatment? H. Gilbert Welch, MD, MPH, has been writing about the pros and cons of cancer screening for years. His book, Should I Be Tested for Cancer? Maybe Not and Here's Why, sets out some eye-opening arguments against cancer screening, regardless of age. "I'm not telling people to never be screened," he emphasizes, "but it is a closer call than most people realize."
Routine screening tests are available for five types of cancer: breast, cervix, colon, prostate and skin. It may seem that being tested is a no-brainer: Find the disease early and you have a better shot at a cure. Despite the fact that many patients and doctors strongly favor screening, Dr. Welch says there are several reasons why this may not be the best course of action, including:
- Screening may find harmless cancers that are never going to progress and threaten your life. Unfortunately, there's no way to distinguish these harmless cases from more dangerous ones. But, once they show up, you'll be treated for a disease that may never have caused you trouble.
- You could get a "false positive" result, suggesting that you have cancer when you really don't. To find out for sure, you'll need more tests. "Some of these tests are unpleasant and some can have serious complications," says Dr. Welch.
- Some medical tests are risky. Colonoscopies carry a small risk (about one in 1,000) of perforating the colon, a serious and sometimes life-threatening complication. Beyond that, recent studies have shown that it isn't clear that the benefits of PSA tests for prostate cancer outweigh the risks of follow-up diagnostic tests and cancer treatment. According to the National Cancer Institute, PSA test results may lead to the detection of small cancers that never would become life threatening but still put men at risk of complications from unnecessary treatments.
Whether or not cancer is found through screening, how well do older folks fare after treatment compared with younger patients?
Although few studies have looked at this issue, some research has been done on the outcome of colorectal cancer treatment. A review showed that patients in their 80s don't do well if they have other serious health problems and if their cancer was diagnosed at an advanced stage. A 2006 Canadian study, though, found that age is not an obstacle to successful treatment.
The Canadian researchers compared the outcomes of colon cancer treatment in patients over 80 with those of patients in their 60s. Both groups had comparable surgery and, in both groups, cancer was diagnosed at an early stage. The study found no major differences between the two groups in terms of their overall health or quality of life. The researchers concluded that what matters most in cancer treatment is not age alone but a range of factors that every patient must consider for him- or herself.
So, should you continue with cancer screenings once you reach your senior years? The answer: It depends. On you, on your overall health, your attitude, and your personal assessment of whether screening and treatment are right for you.