Screening advice changes with age

As unpleasant as colonoscopies and mammograms are, I don’t expect to be delighted about quitting them. It will mean that I’m at the age when my life expectancy is part of the calculation about whether I should be screened.

The US Preventive Services Task Force, an independent advisory board of medical experts, says that routine colon cancer screening might stop after 75, and breast cancer screening at 74. Although they might remind people of Sarah Palin’s “death panels,” the USPSTF recommendations were not made because screenings have to be rationed. The USPSTF says that there is no evidence of benefits from routine colon and breast cancer screening after a certain age.  

A slow-growing cancer — colon cancer usually takes 10 to 15 years to develop — might not affect the length or the quality of life remaining. The life expectancy of 75-year-olds in the United States averages 13 years for women and 11 years for men, less for people with health problems. A study published in the Journal of General Internal Medicine found that Medicare recipients who were between 75 and 79 and had three or more comorbidities did not buy more time with colonoscopies. 

As the USPSTF noted, there isn’t evidence that even healthy older people benefit from colon cancer screening. A Harvard study of 1.3 million Medicare patients found that the risk of colorectal cancer after age 75 was about the same in people who did and did not have colonoscopies. 

Furthermore, the risk of complications from colonoscopy, including perforation, increases with age.

The USPSTF makes an exception for those who have had colorectal cancer or polys or a family history of colorectal cancer. These people should continue to be screened.

It looks like a good idea to me to have a colonoscopy close to age 75. If your last colonoscopy was in your mid- to late 60s and you’re on the usual 10-year schedule, one more colonoscopy seems warranted.

Routine mammograms may be discontinued after age 74, the USPSTF advises. Not only is evidence lacking that screening reduces mortality from breast cancer after this age, there are risks to continued screening, including false alarms, overdiagnosis, and overtreatment.

The American Cancer Society, which goes along with the USPSTF’s recommendations about colon cancer screening, differs about mammograms. The ACS advises women to continue mammograms every year or two as long as they are healthy enough to have a life expectancy of at least 10 years. The ACS’s recommendation sounds sensible to me; the incidence of breast cancer increases with age, and not all breast cancers are slow growing, although they tend to be less aggressive in older women.

Do you expect to live to an advanced age? You and your doctor may decide that you should continue colon and breast cancer screenings. Medicare will pay for a colonoscopy every 10 years for people at average risk of colon cancer and every 2 years for people at high risk. It covers screening mammograms every year and diagnostic mammograms more frequently if medically necessary. Medicare sets no upper age limit for colonoscopies or mammograms.

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