It’s a real bummer getting old- not so much for the actual age, as I love the wisdom and experience that
comes with aging, but for the wear and tear on the body. My feet hurt in the morning. I need special
glasses to see. I find more hair growing in my ears and nose than on my head. I am like a board. My
flexibility, never a strong point for me, continues to wane. The list goes on an on. Then there are the
recommendations from out beloved physicians in regards to screening as we age. Who wants a
colonoscopy or a mammogram? Is this really necessary? I must admit it is better to catch a condition
early on than late in the game, but which screenings are really needed and which ones could be
dangerous? Are the benefits worth the risks? I am not going to give answers. I want you to think and
investigate the health topic of screenings for yourself.
I definitely think it is beneficial to screen for high blood pressure as well as high cholesterol. Note I said
screen and not jump to medications. Awareness can motivate and encourage many to make lifestyle
changes to help change the global chemistry first. Understanding the risks of extra weight, diabetes, and
inactivity is also useful especially when it leads to an early intervention, which carries little risk. Screening
for mental health problems is also important for the same reasons. However, what about the screenings
Does everyone need colon screening at age 50? Do woman at low risk need mammography? Should
anyone get prostate screening? If screening will not alter treatment, should a screening be done? These
are all legitimate questions. Then there are the inherent risks from false positive screenings. These can
lead to unnecessary and risky interventions.
Not too long ago I heard the story of a fellow physician who had a routine chest x-ray. A solitary
pulmonary nodule was discovered. He was at low risk for cancer, a negative family history and no history
of lung cancer in the family. Options were given including waiting and repeated an x-ray or a definitive
diagnosis with a biopsy despite his low risk profile. The biopsy was performed and because of the
location, a thoracotomy to get at the location of the mass was needed. Everyone was relieved when the
pathological specimen revealed no malignancy. However in the process of the thoracotomy, a nerve was
damaged leading to chronic pain. Eventually a narcotic was given and you guessed it, one thing led to
We try to find more cancer because we believe that early detection will improve outcomes. This is not
always the case, as it can sometimes lead to worse outcomes (especially when cancers that are not
lethal are discovered). The treatment can be more dangerous than the condition. Sometimes with
advanced cancer, the treatment might prolong life but hurt its quality. Chemotherapy and radiation are not
There is a tendency to create fear. Patients demand screenings. Screenings are good for business. There
are many guidelines for screening but one size does not fit all. Let’s look at a few of the cancer
screenings we all talk about.
Prostate testing: no good study shows that prostate cancer screening via a PSA test saves lives. Last
month the American Urological Association raised its screening guidelines from age 40 to age 55. At age
55, men should make an informed decision about the potential risks and benefits of biopsy and surgical
side effects, which include infection, incontinence and impotence. There is also a 1.5% chance of death
from treatment. One in thirty men die of prostate cancer while one in six get diagnosed with the condition.
Many men die with prostate cancer not causing the death.
A 2011 study compared men from 55-60 screened and not screened over a ten-year period. To save one
life, doctors had to screen 1000 men for 10 years. Four out of 1000 screened died of prostate cancer
compared to 5 out of 1000 unscreened men. This is the 20% reduction in mortality quoted. The debate
continues as to whether screening for the masses is beneficial. A strong family history of prostate cancer-
induced death is a different case.
Lung cancer: Lung cancer kills more Americans than the next top five cancers combined and smokers
have the highest risk. Routine screening for all is not currently recommended. For those with a 30-year
smoking history (ages 55-75) screening is recommended for those who understand the harms and
Colon cancer: This is the second leading cancer death in America. It has been traditionally recommend
having screening at age 50, if there’s no family history. However colonoscopy is not the only way to
screen. Stool testing is another option. There are no studies that show that colonoscopy is more effective
than stool testing. There has never (to my knowledge) been a perforated colon from a stool test for blood.
I do feel early detection is critical, as if this disease spreads, prognosis is poor.
PAP smears: The recommendation on PAP smears from The Cancer Society is screenings every three
years after the age of 21. If three results are negative, check a PAP smear every year until age 65. Half of
the women who die of cervical cancer never had a PAP smear and more than 90% had not had one in 10
years. This disease is preventable if caught early. Having the test yearly is still contestable.
Mammography: The debate continues: is it better treatment or better diagnosis that is lowering the rate of
breast cancer? If, on a self-screening examination, a lump is found, this needs immediate evaluation. The
current screening recommendations is annual screenings for every woman over 40 per the American
Cancer Society. Without a breast cancer family history, no obesity, or cigarette use, it is more than
reasonable to have a baseline at 40; if normal, another is recommended at 45, 50, and every other year
until 70. After 70, no more screening is suggested. Of course regular screening exams are needed,
checking for masses in the breast. Mammograms do emit radiation and carry some risk. Another hot topic
is breast cancer genetic testing.
The bottom line is for you and I to ask questions when it comes to screenings. Screening guidelines are
just that: guidelines. Right now ask yourself, what should I be screened for? Read the literature. You are
your best earthly physician. Your body is your greatest asset. It amazes me that people spend more time
taking care of everything else except their own body. I would rather find out about any problem early
rather than later. Think about the type of screening you need. Be proactive.