Elderly patients often ask me when they can stop having mammograms, Pap smears and other preventive health maintenance exams. The patient’s current quality of life and expected length of life are important factors in deciding when to stop trying to prevent disease.
Cancers that women are routinely screened for include cervical, colon and breast, while men’s screenings focus on prostate and colon cancers. Cervical cancer is monitored through Pap smears taken during a pelvic examination. If a woman had her uterus removed for reasons other than cervical cancer, most likely the cervix was removed as well and a Pap smear is no longer needed. If a woman still has a uterus, has had no new sexual partners, has no history of abnormal Pap smears, and is over the age of 65, then it is unlikely that she would need to be screened for cervical cancer any longer.
However, a bimanual examination, which helps screen for ovarian cancer, and a breast exam looking for breast cancer should be continued every year as part of a well-woman examination. Therefore it is still important for elderly women to visit their physician yearly. Breast cancer screening may be of benefit as long as a patient has a five- to seven-year life expectancy. Mammograms should be discontinued at age 75.
People should be screened for colon cancer until they have a five- to 10-year life expectancy. There are several different ways to look for colon cancer, such as CT scans, colonoscopies, barium studies and/or stool studies for blood. A thorough discussion with a physician can help identify the best method.
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Prostate cancer has always been a controversial issue. One of every six men will develop prostate cancer during their lifetime, yet only about 3 percent of them will die from it. Most men with prostate cancer never know they have it. For this reason, many physicians do not screen for prostate cancer. The United States Preventative Service Task Force echoes this practice, stating that insufficient evidence exists to recommend for or against screening prostate cancer. However, this decision should be made in consultation with your primary care physician.
Other common causes of disease that older people are routinely screened for include osteoporosis, high cholesterol and high blood pressure. Osteoporosis, or low bone density, is seen only in about 7 percent of women. However, good treatment options exist to decrease the risk of fractures in the back, hip and forearm. Recommendations are to check every woman after the age of 65, or five years after menopause in women who have risk factors. Although it is a disease mainly affecting women, men can develop osteoporosis as well.
High cholesterol or lipids are a risk factor for heart disease and stroke. Screening should begin based on family history, but at least by age 45 for women and age 35 for men. Screening should begin at a younger age if risk factors are identified. Continued lipid screening at intervals of three to five years should continue until age 65 when it can be stopped because the risk of developing high cholesterol is unlikely past this age. Lowering blood pressure causes about a 50 percent reduction in strokes and heart attacks. Yearly blood pressure checks are encouraged.
As always, individual health maintenance and preventive care are best discussed with your physician and customized based on risk factors from your personal, family and social histories. Many guidelines and recommendations exist. Websites that can help you determine your current health status include the American Cancer Society ( www.americancancer.org) and the American Heart Association ( www.heart.org).