Re: Debating Cancer Screening: Too Old to Test?
- From: J <studydras@xxxxxxxx>
- Date: Tue, 15 Nov 2005 06:48:08 -0500
J wrote:
> http://www.nytimes.com/2005/11/15/health/15brody.html
> By JANE E. BRODY
> Published: November 15, 2005
>
(Page 2 of 2)
They suggested that in addition to age and life expectancy, the decision to
screen an older person for colorectal cancer should be based on factors that
increase the likelihood of developing cancer, like a history of inflammatory
bowel disease or previous multiple or large adenomas, as well as factors that
increase the risk of complications from screening or treatment, like the
presence of cardiopulmonary disease.
Breast Cancer
Breast cancer is more common in older women, but it tends to be a slower
growing, less aggressive disease. It is also easier to find by mammography
because the breast tissue of older women is less dense. While all
well-designed studies done in women 50 to 69 found a protective effect of
mammographic screening, only one such trial in eight included women over 70.
This study, done in Sweden, did not show a significant reduction in breast
cancer deaths among women 70 to 74 who had two routine mammograms. In the
first round of screening, 88 percent of the women with positive mammogram
findings turned out not to have cancer on follow-up tests, which included
breast biopsies.
The experts suggested that the decision to continue screening after 70
consider factors like the presence of a family history of breast cancer and a
longer duration of exposure to estrogen (natural and in medication), as well
as advancing age. They said, however, that women with other serious diseases
and life expectancies of less than five years were not likely to gain from
screening.
Cervical Cancer
Cervical cancer in older women is not a more aggressive disease and, when
localized, it responds well to treatment. By now, every woman should know that
Pap smears save lives. They can reduce the incidence of invasive cervical
cancer by 60 percent to 90 percent. Yet few screening studies have included
older women.
According to an analysis of Medicare claims, about 39 of 1,000 older women
would need at least one follow-up procedure within eight months of having a
Pap smear. These procedures range from in-office tests to surgical excisions
and include colposcopy, endometrial biopsy, D and C, and cone biopsy, all with
certain risks.
Another problem involves trying to determine which cervical abnormalities are
likely to progress to cancer, since most resolve on their own without any
treatment.
In addition, changes in the anatomy of older women can make it harder to get
an accurate reading from a Pap smear. After menopause, there is an increased
risk of inflammation that can mimic cancerous cell changes. The experts
suggest that Pap smears should be done in women over 70 who have not been
previously screened, but that women who have had repeated normal Pap smears
can stop screening at age 65 or 70, as can women with a short life expectancy
and those who have had a total hysterectomy.
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