Cancer

With Cancer Screening, Better Safe Than Sorry?

Doctors and medical organizations often advise that past a certain age, older adults can forgo various screening tests for cancer. But many patients, no matter how old or sick they may be, are reluctant to abandon tests they’ve long been told can be lifesaving.

To be sure, among my close circle of septuagenarian friends, none of us have stopped getting annual mammograms, even though I, having previously had breast cancer, am likely to be the only one among them for whom the potential benefit might conceivably outweigh the risks.

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.

Few may realize that ill-advised screening tests come at a price, and not just a monetary one that adds many billions to the nation’s health care bill. Every screening test has a rate of false positive results – misleading indications of a possible cancer that requires additional, usually invasive, testing with its own rate of complications.

A new online survey of randomly selected participants clearly showed that women are more aware of the benefits of mammography screening than its harms. If, for example, a mammogram falsely detects a lesion — a not infrequent occurrence — the false-positive result may cause not only serious emotional distress but also lead to a surgical biopsy, which carries its own risks. And by the time they’ve had 10 mammograms, nearly half of women will experience a false-positive finding.

Likewise for men with a suspicious rise in the PSA test that results in multiple biopsies of the prostate. And colonoscopy itself can be hazardous, particularly for older people whose intestinal walls have become fragile and susceptible to perforation.

Why, you may wonder, do people continue to get tests they don’t need and that may exact costs to their health, time and pocketbook?

A primary reason: The widespread belief that it’s better to be safe than sorry. Why take a chance that a potentially lethal cancer will go undetected until it’s too late for a cure? Doing something is often more appealing than doing nothing. Many who think this way consider only the beneficial “what if’s” and not the possible downsides of cancer screening tests.

Another likely reason: Insurance often pays for the test, so why not take advantage? Indeed, Medicare covers the cost of annual mammograms, including the digital version, which is likely to be…