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Are You Too Old To Be Having That Test?

Older man getting an MRI exam-when medical tests are needed

Do men and women over 75 still need to get colonoscopies?

Does an 80-year-old woman really need a mammogram?

What about a man who's over 75 -- is PSA testing for prostate disease really necessary?

The answer is a resounding "no," say a growing number of doctors and researchers. 

In a  joint story by the Kaiser Family Foundation and the Washington Post, critics question what they see as the over-use of screening tests for older patients, even in cases where it seems unnecessary, even cruel. A recent survey of primary-care physicians, published in the journal  Cancer,  found that nearly half would recommend a mammogram for an 80-year-old woman with terminal lung cancer.

Routine screening for colon, breast and prostate cancer and other ailments in people in their 70s, 80s and even 90s is not only unnecessary and of questionable benefit, say many experts, there is considerable risk from these tests.

The tests can trigger expensive, invasive treatments for slow-growing diseases that may never cause problems, leaving patients worse off than if they had never been tested, some doctors say. In some cases, the treatment may actually reduce a person's quality of life  in the final months.

The U.S.  Preventive Services Task Force, an independent panel of experts that evaluates the risks and benefits of screening tests, does not endorse PSA testing or routine colon screening after age 75. The panel also says there is no evidence for or against mammography after 74, and it recommends that most women stop getting Pap smears to detect cervical cancer after 65.

"More is not always better, and that becomes  particularly true in older Americans where the dangers of medical care grow," Michael LeFevre, a professor of family medicine at the University of Missouri and a co-vice chair of the panel, told the Post.

For example, colon polyps take 10 to 20 years to become cancerous, while the risks from colonoscopy, including intestinal perforation and heart attack, substantially increase after age 80, he said.

For whatever reason -- maybe because Medicare will pay for it, maybe because patients request or expect it -- doctors are still urging their older patients be screened.

Earlier this year, Texas researchers found that 24,000 Medicare patients, ages 75 to 79, who had received a normal colonoscopy result were still getting repeat tests within seven years, some in as few as three years, even though nearly every medical authority recommends the test be done only once every 10 years.

Not everyone agrees that over-testing is a problem as people age. The American Cancer Society has no upper age limit recommendation for colonoscopy or mammography, but does not endorse PSA testing. A spokesman told the newspaper he thinks under-screening is a bigger problem than over-testing.

And some elderly patients disagree -- vociferously -- as well. In an article by family physician Pamela M. Davis in the L.A. Times, she recounted her 86-year-old mother's reaction to Davis' suggestion that she no longer needed a mammogram or other tests "at your age."

"My mother was furious," wrote Davis, saying her mother accused her of just wanting  "to save money to spend on the young people and just let us old folks die."

The issue is a touchy one, Davis admitted.  "All of my patients, like my mother, deserve the best. It's just not always so easy deciding what the best is."


Photo credit: Sean Justice/Corbis

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