Yet Elena, who entered a nursing home in November, was screened for breast cancer as recently as that will summer. “If the screening can be not too invasive, why not?” asked her daughter, Dorothy Altemus. “I want her to possess the best quality of life possible.”
although a growing chorus of geriatricians, cancer specialists along with health system analysts are coming forth that has a host of reasons: Such testing inside the nation’s oldest patients can be highly unlikely to detect lethal disease, hugely expensive along with more likely to harm than help since any follow-up testing along with treatment can be often invasive.
along with yet such screening — some have labeled the idea “overdiagnosis” — can be epidemic inside the United States, the result of medical culture, aggressive awareness campaigns along with financial incentives to doctors.
By looking for cancers in people who are unlikely to benefit, “we find something that will wasn’t going to hurt the patient, along with then we hurt the patient,” said Dr. Sei Lee, an associate professor of geriatrics at the University of California-San Francisco.
Among people in their 70s along with 80s, cancer screenings often detect slow-growing tumors that will are unlikely to cause problems in patients’ lifetimes. These patients often die of something else — by dementia to heart disease or pneumonia — long before their cancers might ever have become a threat, said Dr. Deborah Korenstein, chief of general internal medicine at brand-new York’s Memorial Sloan Kettering Cancer Center. Prostate cancers, in particular, are often harmless.
“the idea generally takes about 10 years to see benefit by cancer screening, at least in terms of a mortality benefit,” Korenstein said.
Even some patients with terminal cancers continue to be screened for different malignancies.
Although screenings can extend along with improve lives for healthy, younger adults, they tend to inflict more harm than not bad in people who are old along with frail, Korenstein said. Testing can lead to anxiety, invasive follow-up procedures along with harsh treatments.
“In patients well into their 80s, with different chronic conditions, the idea’s highly unlikely that will they will receive any benefit by screening, along with more likely that will the harms will outweigh the benefits,” said Dr. Cary Gross, a professor at the Yale School of Medicine.
“Overdiagnosis can be serious,” Gross said. “the idea’s a tremendous harm that will screening has imposed. … the idea’s something we’re only beginning to reckon with.”
Taxpayers usually foot the bill for these tests, because most seniors are covered by Medicare.
A Hard Habit To Break
Many older patients expect to continue getting screened, said Dr. Mara Schonberg, an associate professor at Harvard Medical School along with Boston’s Beth Israel Deaconess Medical Center.
“the idea’s jarring for someone who’s been told every year to get screened along with then at age 75 you tell them to stop,” she said.
John Randall, 78, says he plans to live into his 90s. He sees no reason to skip cancer screening.
“I, for one, do not like to hear what my life expectancy can be,” said Randall, who lives near Madison, Wis. He plans to have his next colonoscopy in January. He feels healthy along with walks 2 miles at a stretch several days a week. “No one knows when I am going to die.”
Such campaigns have convinced many women that will “mammograms saves lives.”
Colonoscopies, which require extensive bowel cleansing before the procedure, also can leave many older people dehydrated along with prone to fainting.
Even removing nonfatal skin cancers can cause problems for older patients, said Dr. Eleni Linos, an associate professor at the University of California-San Francisco School of Medicine. Frail patients can struggle to care for surgical wounds along with change dressings; their wounds are also less likely to heal well, Linos said. More than 1 in 4 patients with nonfatal skin cancers report a complication of treatment, Linos’ research shows.
Screenings, follow-up tests along with treatments can cause emotional trauma as well.
“For a woman of that will generation who doesn’t possess the cognitive ability to understand what’s going on, having private parts of their body exposed along with pressed against a machine can be very agitating along with upsetting,” Lee said.
Among older women, about 70 percent report significant stress at the time of a biopsy, Schonberg said. Simply lying on a table for a 45-minute biopsy can cause pain for women with significant arthritis, she said.
Virtually all older women with breast cancer wind up getting surgery, which poses additional hardships, Schonberg said. Many are prescribed hormonal therapies that will can cause bone pain, fatigue along with increase the risk of stroke.
Jay Schleifer, 74, of Wellington, Fla., was diagnosed that has a low-risk prostate cancer last year. Since then, his doctor has monitored him with additional tests. He’ll be treated only if tests suggest his cancer has become more aggressive.
that will less aggressive approach aims to spare Schleifer by long-term side effects.
Men are more likely to regret their prostate cancer treatment decisions if they don’t understand the risks beforehand, said Hoffman, director of general internal medicine at the University of Iowa Carver College of Medicine/Iowa City VA Medical Center.
Harold Honeyfield, 87, said he didn’t fully understand the risks when he had prostate cancer surgery 12 years ago. Although he can be glad he was treated, the surgery caused irreversible erectile dysfunction, which has caused stress along with sadness for him along with his wife of 47 years.
“When a man has no erections, that will can be paralysis,” said Honeyfield, of Davis, Calif., who began a support group for different men dealing with prostate cancer. “You’ve lost the ability to be a man.”
A Tough Sell
Doctors have many incentives to continue ordering screening tests as people age.
“the idea’s a lot easier to say, ‘Fine, get your regular mammogram that will year,’ than to possess the much more difficult conversation that will the idea’s not helpful when life expectancy can be limited,” Gross said.
Schonberg said she tries to be diplomatic when talking to patients about halting screening.
“the idea’s hard to tell people, ‘You’re not going to live long enough to benefit,'” Schonberg said. “that will doesn’t go over well.”
Many physicians continue screening older people because they’re afraid they’ll be sued if they miss a cancer, Schonberg said. along with she notes that will some health systems award bonuses to clinicians whose patients have high screening rates.
In addition, “doing less can be perceived as a lack of caring or as ageism,” Schonberg said. “the idea can be uncomfortable for a physician to explain why doing less can be more.”
Doctors should prioritize what they can do to help patients be healthier, said Dr. Louise Walter, chief of geriatrics at the University of California-San Francisco along that has a geriatrician at the San Francisco VA Medical Center. For many older patients, screening for cancer can be not their most pressing need.
“Instead of spending time along with effort on things that will are hurtful along with never going to help them, why not direct time along with energy on things that will will help them live longer along with better?” Walter asked.
For example, Walter might tell a patient, “‘Right at that will point, you have genuinely bad heart failure along with we need to get that will under control,'” Walter said.
different key issues for many older people include preventing falls, treating depression along with alleviating stress in their caregivers, Walter said. Gross said he urges patients to take steps shown to improve their health, such as getting a flu shot or exercising at least 15 minutes a day.
“These are things that will can help them feel better very quickly,” Walter said. “Screenings can take years to have a benefit, if at all.”