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50+: Live Better, Longer

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Elderly Should Get Colon Cancer Test, Expert Says


There is an ongoing debate among experts about the need for various cancer screenings in the elderly. Colon cancer is a focus of this disagreement, Dittus says. "Right now I think most people would say that screening is too costly and probably ineffective after age 70. These data dispute that belief."

But another researcher at the same meeting argued that colon cancer screening is not effective after age 80.

Scott Rich, MD, MPH, from Dartmouth Medical School, based his findings on the effect of another colon cancer screening tool: fecal occult blood (FOB) test. In this test, a sample of feces is examined for traces of blood that can?t otherwise be seen, a sign that cancer may be present in the colon. Rich calculated the days of life that would be lost if screening were halted.

"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.

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