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With Cancer Screening, Better Safe Than Sorry?

 5 months ago       106 Views

I’ve met people with no known risk for colorectal cancer who continue to get colonoscopies well past the age of established recommendations.

Not to mention the countless men at low risk for prostate cancer who continue to get PSA tests, often at the suggestion of their doctors, when the best evidence says that for such men the test can result in more harm than good.

The Affordable Care Act (Obamacare) requires health plans that started on or after Sept. 23, 2010, to cover colonoscopy as a screening test (although older plans may not), and Medicare covers the cost of this test every two years for people 50 and older at high risk and every 10 years for people at average risk.

And doctors often believe at least as strongly as their patients do in the benefits of screening tests.

However, as the Hopkins team found in interviewing 40 older adults, many people believe that doctors cannot accurately predict a person’s life expectancy and don’t want to consider how long they may live when making screening decisions.

Rather than being told: “You may not live long enough to benefit from this test,” patients are likely to prefer a more positive message like: “This test would not help you live longer,” the team concluded.

Breast Cancer: Screening mammography every two years is recommended for women ages 50 to 74.

Prostate Cancer: According to a draft recommendation, for men ages 55 to 69, doctors should inform them that screening “offers a small potential benefit of reducing the chance of dying of prostate cancer,” as well as the potential for harm from testing of overdiagnosis, overtreatment and ensuing complications.

Screening is not recommended for men 70 and older.

Screening adults aged 76 to 85 should be individualized depending on the patient’s overall health and prior screening history; they should have a reasonable life expectancy and be healthy enough to withstand treatment if cancer is found.


Author: JANE E. BRODY

Source: nytimes.com