Elderly Should Get Colon Cancer Test, Expert Says
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"At age 80, colon cancer screening with fecal occult blood has very little benefit," Rich tells WebMD. Dittus says, however, that fecal occult blood is poor a screening device because it is unlikely to detect pre-cancerous lesions. "Usually, the cancer is already advanced when fecal occult blood detects it," Dittus says.
Asked if he would adjust his recommendations if colonoscopy, not fecal occult blood, were the screening method, Rich says, "I think it would make a difference because colonoscopy is clearly the gold standard." Nonetheless, Rich says, it is still necessary to consider "putting an outer limit on screening recommendations. I think that after age 85, one is probably pushing the envelope."
In his paper, he also suggests that screening for cervical cancer should be "stopped at age 65 for women who have a history of negative Pap tests" and that " breast cancer screening with mammography is probably not necessary after age 75." Setting these limits would not only save money, says Rich, but could alleviate patients' anxiety.
Dittus agrees that some upper limits are necessary. He says that for colon cancer, the limit should be 90: "At age 90 and beyond, colonoscopy screening probably does more harm than good." He says that treatment of colon cancer can cause a great deal of discomfort, which may be too extreme for a 90 year old.
Dittus says he hopes that public sentiment will build to pressure Congress to direct Medicare to pay for one-time colonoscopy.
"Medicare doesn?t pay for preventive services unless it can be proved that they are cost-effective," Dittus says. That proof requires more than one study, he says. "Our study will be published and then we need another study to reproduce these findings; that will take years and people will continue to die."
The alternative is a public campaign to influence Congress. Such a campaign resulted in Congress directing Medicare to pay for screening mammography, says Dittus.
"We are hoping that Katie Couric and the attention she is bringing to colorectal cancer will be helpful," Dittus says. Television personality Couric has been campaigning to raise awareness of colorectal cancer since the death of her husband as a result of the cancer. A few months ago, she allowed her own colonoscopy to be broadcast.