Too Old To Screen

There are 37 million people in the United States are 65 and older and the  U.S. Preventive Services Task Force recommends against routine screening for breast, colorectal, and prostate cancer at age 75 and beyond, and advises against cervical cancer testing after 65.  But the screenings still occur.   A study published in the Dec. 12/26 issue of the Archives of Internal Medicine gives some examples:

  • Among women 75 to 79 years old, 62 percent had received a mammogram to screen for breast cancer in the past two years, as had 50 percent of women 80 and older.
  • Pap screens for cervical cancer were done on 53 percent of women 75 to 79, and 38 percent of women 80 and older.
  • Fifty-seven percent of men and women 75 to 79 were screened for colon cancer in the previous two years.
  • Prostate cancer screening was undertaken by 57 percent of those 75 to 79; 42 percent of men 80 and older; and 40 percent of those 50 to 74.
Why does this still happen?  In my experience, no logical discussion using facts from the USPSTF will convince an elderly person NOT to get a free screening done.  The only convincing they would ever need is to tell them they had to pay some of the testing cost out of their own pockets.  Even if they had to pay only 5-10% you would still convince 99% of them not to get the test.  Cased closed.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  4 comments for “Too Old To Screen

  1. David Lubin, MD
    December 14, 2011 at 7:44 pm

    The problem is we’re talking about screening general, or age grouped populations. So it relates to the SCREENING of MASSES of people, regardless of age. The problem is that patients don’t look at the masses. Everyone knows someone who died of breast or prostate cancer at a young age, even younger than the recommended…if you’re gonna screen anyway…screening age. So the thought is, “Well, if there’s a chance of finding out if I have cancer, then I want to be tested.” KIng Doug is correct, make them pay and then it’s “Whatever will be will be.”

  2. Michelle
    December 14, 2011 at 12:24 pm

    It sounds like these elderly patients may have a higher screening rate than the younger patients who benefit more, espeically in cervical cancer screeing.

  3. J. R. Johnson
    December 14, 2011 at 11:00 am

    I was recently an expert witness for the defense in the case of un-screened man who died of prostate cancer. Regardless of the guidelines (USPSTF now recommends against doing screening PSAs in all ages), how can we expect physicians to stop cancer screening in patients if lawyers continue to file lawsuits claiming screening psa should be done? Btw, the jury decided in favor of the physician, but it was a split decision and it took 3 days of deliberation to come to a verdict. It is quite plausible that with a slight change in the jury make-up that the doctor would have been found guilty. Unfortunately, it is the lawyers and juries that determine “standard of care”, not the medical professional organizations.

  4. Diane Haugen
    December 13, 2011 at 8:41 am

    In contrast to the “let them die because they are old” attitude, your readers might take a look at Peter B. Bach’s article “When Care is Worth It, Even if End is Death” which appeared in the New York Times yesterday.

    As my husband, a physician, says, any time you plan to deprive care, you are planning on someone’s dying.

    You can hide behind statistics. You can hide behind the recommendations of task forces. However, the results remain the same.

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