Monday, October 26, 2009

Cancer Tests for the Elderly

The Chicago Tribune had an interesting article on the conflicting advice seniors receive regarding testing for cancer. I hadn't thought much about the need or effectiveness for these tests in the elderly. In our society, it seems like we are still bent on preventing and treating illness at any cost. If that is still true, then age shouldn't matter. However, when we factor in Advance Directives, costs, and end of life issues, we may come to a different conclusion. Detecting cancer early results in more effective treatments and increased odds of remission. This is true of breast, colon, and cervical cancer when it comes to those under age 65.

On the other side are the potential costs, which can include unnecessary treatments for cancers that never would have become life-threatening, the anxiety and distress associated with cancer diagnosis, the complications associated with screening procedures or therapies, and medical expenses. Take colon cancer. Although detecting a polyp is advantageous at age 50, the benefits are less clear at 80. Typically, polyps take 10 to 15 years to become cancerous and potentially life-threatening, and often seniors will die of other ailments before it happens, said Dr. Neal Persky, a geriatrics specialist at the University of Michigan.

The argument then becomes whether one can assign an age cut off, as seniors are not "one size fits all." Some medical experts believe that if a senior is healthy and would be a good candidate for treatment, then they should take the test.

The influential U.S. Preventive Services Task Force, an independent group that rigorously evaluates preventive services, has suggested stricter standards. It favors ending screenings when evidence indicates most people of a certain age are more likely to die of another condition -- say, stroke or heart failure -- than of cancer. For colon cancer, it sets the bar at 86; for prostate cancer, 75. Older people are more likely to experience complications from the tests and less likely to reap benefits, said Dr. Ned Calonge, task force chairman.

An important question for seniors to consider is what they would do if cancer is found. If they would not pursue treatment, then there is no need for screening. If however they would want chemo, radiation, or surgery, then they should ask to be tested. Above all, a senior must advocate for their wishes either way.

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