Recently, I told you about yet another study that questions the value of routine screenings for breast cancer in women and prostate cancer in men. Simply put, these screenings don’t save lives. In fact, in most cases, these screening only turn up harmless growths that probably wouldn’t have caused any trouble in the patient’s lifetime if left alone.
Aside from all the technical problems and false positives of these screening tests, we must ask this simple, common sense question: How long do we screen patients for cancer as they grow older?
You see, there is no point screening a patient for breast or prostate cancer if he or she has a life expectancy of fewer than 10 years. Even back when I was in training 40 years ago, we already understood that many women with biopsy findings labeled as breast “cancer” would typically survive 20 years or more into healthy, advanced ages.
It was also typical to find changes labeled as “cancer” in the prostate glands of healthy men who had died at advanced age of something else, or simply “old age.” But these cancers never invaded, never metastasized, and never caused health problems of any kind, let alone death. They were incidental findings. As pathologists we called it “occult” cancer, meaning hidden.
It seems the cancer screening industry has been working its occult magic on the public ever since, putting out propaganda that “early screenings save lives.” But the real data tell us otherwise.
Screenings given inappropriately in older men and women
According to a major, new study published in January in JAMA Oncology, nearly 16 percent of men and women ages 65 years or older in the U.S. who have life expectancies of less than 10 years still receive breast cancer and prostate cancer screenings. Guidelines from the National Comprehensive Cancer Network clearly recommend against mammography and PSA screening in these individuals. Yet clearly, the screenings still happen.
For this study, researchers looked at data for 149,514 men and women older than 65 years who had completed a health and longevity assessment in 2012 and had not been diagnosed with cancer.
Fifty-one percent of both men and women had a cancer screening test (a PSA test given to men and mammography given to women), despite the fact that 31 percent of them had a life expectancy of less than 10 years, according to the assessment they took in 2012. Colorado had the lowest rate of non-recommended screenings (12 percent). And Georgia had the highest rate (20 percent).
Of course, since 2012, the U.S. Preventive Services Task Force has recommended against using the PSA test on any man at any age. So that would mean 100 percent of the screenings on men were “inappropriate” to begin with. And as I often report, several large, recent studies question the value of routine mammography screenings in the population as a whole.
Risk far greater than benefits for older adults
The researchers cited evidence that the risk for these cancer screenings among older adults is greater than their benefits. In other words, the screenings lead to unnecessary biopsies, surgeries and treatments. Plus, they contribute to the overdiagnosis and overtreatment epidemic, which costs $1.2 billion annually.
You may wonder, as I did, about the accuracy of those surveys that predicted fewer than 10 years of life expectancy among the older people who were screened inappropriately. But the researchers looked very carefully at the health assessment. And they said, if anything, they over-estimated life expectancy.
Ironically, when we turn 65 years old, we all have to go under Medicare coverage. And Medicare provides generous coverage benefits for cancer screenings. But by the time you’re eligible, you probably don’t need it.
According to this study, using the current, questionable screening guidelines, up to one in five people get inappropriate cancer screenings, depending on the state in which they. Tragically, we all end up bearing this cost, no matter the state in which we live!
- “Prevalence of Nonrecommended Screening for Prostate Cancer and Breast Cancer in the United States,” JAMA Oncology, (www.oncology.jamanetwork.com) 1/21/2016