National recommendations for cancer screening in older adults have changed significantly in recent years. Changes are related to an increased recognition that cancer screening decisions are often complex in adults who are aged 75 years and older.
Screening guidelines encourage healthcare providers and their patients to consider other factors in addition to age - such as estimated life expectancy, general health, values and preferences, and past screening history - when making decisions about whether to have cancer screening tests.
Life expectancy, however, has been greatly debated as a measure for determining cancer screening, and among a national sample, more than 60% of older adults (aged 50-80) disagree that decisions to stop cancer screening should be based on life expectancy.
Likewise, 60-70% of older adults say it's not a problem for older adults to get cancer screenings when guidelines suggest they should not, which challenges the concept of "overscreening" discussed by many experts and healthcare providers.
Interestingly, another national survey showed that projected life expectancy did not seem to influence screening decisions, anyway.
What are "common" cancer screenings?
Common cancer screenings include prostate cancer for men, breast and cervical cancers for women, and colorectal (colon) cancer for both.
Prostate cancer screening involves a digital (finger) rectal exam and blood test.
Breast cancer screening involves a manual (hand) breast exam and a mammogram or ultrasound.
Cervical cancer screening involves a manual (hand) pelvic exam and a pap smear (insertion of a speculum and swabbing of cervical cells).
Colon cancer screening can be accomplished through several methods, though the most common in older adults is a colonoscopy.
Ages for common cancer screenings
The guidelines on when to start and stop cancer screening are based on evidence from clinical studies of the benefits and harms of screening, the age at which specific cancers tend to occur, how fast cancers progress, life expectancy, and personal health factors.
Screening tests are repeated at specific intervals. The recommended interval depends on age, medical history, family history, the type of test performed, and the results of previous screening tests.
Again, while there are nationally supported age recommendations for common cancers, the decision to stop routine cancer screenings should be discussed between your loved one and their provider. The U.S. Preventive Services Task Force recommendations are:
Prostate: General guidelines recommend starting at age 55, age 50 for men at moderate risk, and a PSA screening is recommended between the ages of 40 and 54 if there is at least one first-degree relative (father, brother) who has had prostate cancer. There is no recommended age to stop prostate cancer screening. That should be a discussion between your loved one and their provider.
Breast: General guidelines recommend starting at age 40 and continuing through age 74, with an exam every year between the ages of 45 and 54.
Cervical: General guidelines recommend starting upon becoming sexually active, though definitely between the ages of 21 and 25, regardless of sexual activity status, and continuing through age 65.
Colon: General guidelines recommend beginning regular screening at age 45 and continuing through age 75. Those aged 76 to 85 should talk to their provider about screening.
Why would my loved one stop cancer screening?
Put simply, either because the detriments of screening outweigh the benefits (their provider will discuss this), or because your loved one no longer wishes to have screenings.
The benefit - in fact, the goal - of cancer screenings is to prevent death from cancer through early detection and immediate treatment. Some cancers may be more easily treated or cured if discovered early; therefore, some cancer screenings may reduce the risk of death due to cancer. So, wait, what's the downside?
In general, people above the ages established by the Task Force, have a greater likelihood of being harmed by rather than benefitting from these tests. These harms can include false positives (indicating cancer when it isn't there) that lead to unnecessary follow-up procedures (such as additional imaging, biopsy, and medications).
Furthermore, screening tests usually detect slower-growing cancers that can take 10-15 years or more to reveal their benefits. Therefore, the older your loved one is, the less likely they are to reap those benefits.
There may even be harm from the tests themselves, as all of them are medical procedures that have potential side effects. The risk of harm is highest, of course, for invasive tests such as colonoscopies.
There may also come a point, independent of any research findings or collective expert opinions, when your loved one simply chooses not to continue engaging in uncomfortable cancer screenings. In this case, do not assume that you know what's best for your loved one and push them back into screenings. Rather, support them by acknowledging their feelings, letting them know their wishes will be honored, and encouraging a discussion with their provider.