Unfortunately many health care agencies that provide accreditation or insurers who pay for the screenings rely on age-based guidelines for assessing quality or reimbursing for care. These factors may influence physician ordering of screening tests more than the actual usefulness of the information the screening tests provide. Lead author of the study, Louise Walter, MD a geriatrics fellow said "Because health status among the elderly varies much more from person to person, screening decisions require a more rational approach in this population.
In the report paper Walter and her co-author, Kenneth Covinsky, MD laid out a series of steps for doctors to follow, to help them decide rationally whether or not to screen an elderly patient. "We hope this paper will give doctors more confidence in making rational decisions about whether or not to recommend screening, by helping them consider a whole range of patient characteristics, and not just age," said Walter.
One of the most important factors to consider when deciding whether or not to order cancer screening is the patient's life expectancy. "If a patient has other illnesses and only has a five-year life expectancy, then it doesn't make sense to screen them for breast cancer or another cancer when we know from research that patients so not benefit from screening for at least five years," the author said.
For example, a very healthy and active 80 year-old who could be expected to live possibly 13 years longer, is more likely to be helped by cancer screening than a 70-year-old who has severe congestive heart failure along with other major health problems who is unlikely to reach age 75.
The study also includes charts that doctors can use to estimate life expectancy and the likelihood that a patient will benefit from screening for colorectal can breast cancer or cervical cancer.
The risks and burdens of every screening test should be considered carefully before being ordered. Screening test results can be inaccurate or inconclusive necessitating further, often invasive testing such as biopsy and additional stress for the patient. Patients with advanced illnesses and limited life expectancies can suffer unnecessary harm and complications from finding an early cancer and having surgery or other invasive treatments. Many cancers found early through screening tests would not have progressed quickly enough to affect these patients during their limited lifetime.
In the case of those patients with dementia, a screening test and work-up can be a very traumatic and scary experience. It may be traumatic enough to significantly decrease their quality of life.
Ultimately the decision, that any physician should respect to have a screening test or not should be the patients. It is very important that physicians discuss both the risks and the benefits of screening tests and respect the decision the patient makes. Many patients will get relief and piece of mind from having a screening test, while others may not want to have a test if they can avoid it at all no matter the risk.
