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When to stop cancer screenings

Created date

November 22nd, 2011

Medical science has certainly come a long way. Research has provided answers to many questions, and technology has made it possible for people to be screened for many serious diseases, including cancer. The word screening means looking for signs of a disease in someone who has no symptoms, and in the case of cancer, early detection is generally thought to be essential for effective treatment. But recently there has been some controversy about the necessity of some cancer screening for older adults particularly with regard to prostate, breast, and cervical cancer tests. Cancer screenings are being studied more carefully so there s a lot of change with regard to screening recommendations, says Myla Carpenter, M.D., medical director of Charlestown, an Erickson Living community in Catonsville, Md.

Prostate cancer ' screening

Some experts believe that the PSA is important because it can lead to earlier cancer treatment, which in turn may help save lives. They believe that all men over age 50 who have a life expectancy of at least ten years should have an annual PSA test. Other experts, including members of the U.S. Preventive Services Task Force (USPSTF), have recently recommended that the PSA should no longer be performed on healthy men. They based this recommendation mainly on research showing that the benefits of PSA screening may not outweigh the risks of follow-up diagnostic tests and cancer treatments. While the PSA can detect small cancers, these tumors may never become life threatening because many prostate cancers grow slowly. Further diagnostic tests and cancer treatments, however, may result in temporary or permanent impotence, incontinence, or other complications. And in the case of fast-growing cancers, the USPSTF found from evidence reviews that PSAs have not saved lives. According to the American Cancer Society (ACS), however, research has not yet proven that the potential benefits of testing outweigh the harms of testing and treatment. ACS recommends that men have a thorough discussion with their doctors about PSA testing starting at age 50, earlier if they are at high risk.

Breast cancer ' screening

A mammogram is a special type of x-ray that can show tumors long before they are big enough for you or your health care provider to feel. According to Susan G. Komen for the Cure, mammography correctly identifies about 83% of women who truly have breast cancer. Nonetheless most experts say that a woman can stop having mammograms after age 75, unless she has had cancer or is at high risk for the disease. As with prostate cancer, further diagnostics or treatment could result in pain, disability, or disfigurement when the cancer itself may not be likely to cause a problem in a woman s remaining years. Two years ago, the USPSTF recommended that women in their 40s should no longer get routine mammograms. This recommendation came under fire by medical experts and was changed to every one to two years for women 40 and over. Now, based on new evidence, mammography is recommended every two years for healthy women. Studies showed that there was no increase in mortality rates with women being screened every other year, Carpenter says. The strongest evidence of mammography s benefits (particularly reduced mortality from breast cancer) continues to be among women ages 50 to 69.

Cervical cancer ' screening

A Pap test has long been the gold standard for early detection of cervical cancer and is proven to reduce the number of deaths from the disease. The test itself involves taking a sample of tissue from the cervix and examining it for cancerous or precancerous cells. Women typically start having these tests regularly every one to three years sometime in their 20s or earlier in certain instances. Clinical recommendations vary somewhat when it comes to this test. The USPSTF recommends that screening stop at age 65 if you ve had normal Pap tests in the past and you re not at high risk for cervical cancer. The American College of Obstetricians and Gynecologists (ACOG) says that women between the ages of 65 and 70 may stop if they ve had three normal tests in a row and no abnormalities in the past ten years. The American Cancer Society guidelines use the same criteria as ACOG but recommend stopping the test at age 70. Women who have had a complete hysterectomy no longer need pap smears because their cervix was removed. According to the Agency for Healthcare Research and Quality, most older women think lifelong cervical cancer screening is important. Despite recent changes in clinical recommendations, 77% of women planned to have Pap tests for the rest of their lives. Women tend to enter the health care system earlier than men because of the necessity of gynecological care. It sets the pattern for lifelong preventive care, says Dean Smith, R.N., B.S.N., ' director of nursing at the Specialty Hospital at Levindale in Baltimore, Md.

Your personal ' preferences

I encounter mixed reactions by people, Carpenter says. Some wish to continue screenings after they are no longer necessary, while others are delighted that they don t have to. Before undergoing cancer screening, ask yourself this question: What am I going to do with the information? Carpenter advises. If you don t intend to proceed with further diagnostics or if you wouldn t be able to tolerate treatment, then there s no point in undergoing screening. Cancer screening recommendations are always changing because of new research findings, Carpenter continues. You should always discuss them with your doctor based on your personal health status and preferences.