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How Old Is Too Old To Continue Screening?

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How do you react to the news that a 100-year-old woman has just had her first mammogram? Boo or cheer?

Robert Smith, PhD, was appalled at a loud cheer when an announcement at a medical meeting heralded just such a milestone. “Several of us were just shaking our heads in disbelief,” he said, “because it makes absolutely no sense whatsoever to put a 100-year-old woman through a mammogram.”

And Dr. Smith, as director of screening for the American Cancer Society, is a screening hawk. “As long as a patient is in good health and a candidate for treatment, they are a candidate for screening indefinitely,” he told Sandra G. Boodman for a story headlined: “Concern Is Growing That The Elderly Get Too Many Medical Tests.” The article was published jointly by Kaiser Health News and The Washington Post.

The article cites such excesses as a virtual colonoscopy for a 99-year-old woman. And such tragedies as the case of a theretofore healthy 78-year-old man who underwent radiation treatment for prostate cancer—a disease that typically progresses too slowly to seriously bother, let alone kill, someone of that age—and was left impotent and incontinent.

How old is too old for screening or other imaging tests? Do we side with Dr. Smith, who thinks that underscreening is more of a problem than overscreening, even among the elderly? Or with Mark Klein, MD, a Washington, DC, radiologist, who said:

The most important thing on any referral is the date of birth. The game is not finding things. It’s can you improve mortality? And if you do find something, it’s very hard for a doctor to say, ‘Don’t do anything.’

Pamela Davis, MD, a family-practice physician and director of the Family Medicine Residency Program at Northridge Hospital Medical Center in Northridge, California, discovered that when a doctor does say “Don’t do anything,” the patient may not react well. When she told a healthy, active 86-year-old woman that mammograms and colon cancer tests were no longer necessary “at your age,” the woman became furious and responded:

You doctors just want to save money to spend on the young people and just let us old folks die.

The woman was Dr. Davis’s mother.

When Dr. Davis wrote about the experience in a Los Angeles Times article, the doctor received a flood of angry responses, some from fellow physicians, accusing her of the same thing.

Money is always a consideration. Money being made from imaging procedures, ever-growing amounts of money being spent on health care, money not being spent by insurance companies.

However, Dr. Davis would certainly spend any amount of money, from her pocket or any other, if she thought it helpful for her own mother. What’s best for individual patients of whatever age will certainly vary. Reasonable, well-intentioned people will argue about screening and other tests for the elderly.

However … maybe we can all agree that a centenarian doesn’t need a mammogram, and work back from there.

Related seminar: Review for Practicing Radiologists


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