En Español | If you're over 70, regular screening tests — especially when it comes to cancer — may be a big waste of time, say a growing number of health experts worried about the overtesting of those who are in their 70s, 80s and even older. These experts' concern is that unnecessary screenings could lead to invasive procedures or treatments that leave patients worse off than before, especially among those with serious health problems such as heart disease.
Here, we outline the four tests you may be able to avoid — with your doctor's blessing, of course — as well as two tests you should get, if you haven't already.
Having a colonoscopy past age 75 may do little to protect you against cancer, reports a new Harvard study of more than 1.3 million Medicare patients ages 70 to 79. Researchers found the cancer risk dropped from about 3 percent to a little more than 2 percent over a span of eight years. At the same time, other studies have shown, the risk of complications from the test increases with age, especially for those in their 80s. The U.S. Preventive Services Task Force (USPSTF), an independent advisory board of medical experts, recommends that screening for colorectal cancer in adults 76 to 85 "be an individual decision," based on overall health and careful consideration of potential benefits and risks. Obviously, if you've had a polyp removed or have a family history of colon cancer, your risk is higher and you should probably be screened. If not, you may be able to finally skip all that lovely laxative prep.
The experts pretty much agree that women should get a mammogram every one to two years until age 75. After 75, however, the evidence for continuing the exams is murky. The USPSTF says there is "insufficient evidence" to conclude yay or nay to mammograms past 74. A large European study of women 70 to 75 showed that screening mammograms may have limited benefits and could lead to overtreatment, putting some women at risk from harmful side effects. For women with several chronic conditions that could affect their life expectancy, the benefits of routine mammograms after 75 are questionable. Those women should discuss with their doctors whether continuing the exams is really necessary.
No medical group recommends a PSA screening for prostate cancer past age 75, yet recent research published in the Journal of the American Medical Association found that 41 percent of men in this age group still have the test, many at the recommendation of their physician. Talk with your doctor, but many men age 76-plus can skip this.
After age 65, most women with no previous cancer or precancerous lesions are good to go if they've had three negative Pap smears to check for cervical cancer in the previous 10 years. Unfortunately, most women have become so accustomed to having an annual Pap smear that they have them even after undergoing a hysterectomy, according to a study. So, ladies, assuming your physician agrees, you can cross this test off your annual to-do list.
2 Tests You Should Get
Bone Density Scan
While women should be getting routine bone density scans beginning at 65 (or earlier, depending on their risk factors), men 70 and older also need to get a bone mineral density test to check for osteoporosis. This weakening of the bones is often considered a "silent disease," because its symptoms can develop unnoticed until a bone fracture occurs. In men, osteoporosis begins later than in women, and progresses more slowly, but the problem is growing among men who are 70-plus, notes the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Indeed, by age 65 or 70, men and women are losing bone mass at about the same rate, making this screening test critical for everyone — men as well as women — over age 70.
Abdominal Aortic Aneurysm Screening
Men 65 to 75 who have been smokers anytime during their lifetimes should have a onetime ultrasound to screen for an abdominal aortic aneurysm (AAA). The aorta, the main artery supplying blood to the body, extends from the chest to the abdomen. Men who have smoked are at higher risk for the aorta to rupture, which is usually fatal, but if an aneurysm is caught before rupturing, it can be successfully repaired by surgery. The evidence is unclear whether routine screening would benefit women ages 65 to 75 who have been smokers in the past, notes the USPSTF, but the panel recommends against AAA screening for women who have never smoked.