Source: Kaiser Family Foundation analysis. Original data and detailed source information are available at http://kff.org/JAMA_06-11-2019.
Screening after age 75
Published: November, 2011
Screening guidelines often change after age 75. If you're in that age group, how do you decide which tests you need?
If you're close to age 75, you may have followed the same schedule for mammograms, Pap smears, and other screening tests for decades. And if you're like many women, you may be surprised that your physician is suggesting fewer tests or longer intervals between them. The practice seems to fly in the face of conventional wisdom. After all, the risk for many degenerative diseases increases with age, so shouldn't older women be monitored even more closely? The answer is, "It depends on the woman."
By age 75, there's a growing disparity in "biological" age among women of the same chronological age. "I have patients who are quite frail and others who are in better shape than many 50-year-olds," says Dr. Monera Wong, clinical director of the Geriatric Medicine Unit at Massachusetts General Hospital in Boston. Statistics back her up: at age 75, 25% of women live an average of 6.8 more years, 50% live an average of 11.9 more years, and 25% live an average of 17 more years.
In general, the more chronic conditions a woman has, the shorter her life expectancy. A woman who has fewer years left and is focused on her overall function may not benefit from detecting a slow-growing cancer that's unlikely to affect the length or quality of her life, while another woman who has a longer life expectancy probably would.
How screening guidelines are developed
Screening tests are examinations aimed at detecting disease before symptoms develop. They range from simple, noninvasive tests like blood pressure measurements to procedures such as colonoscopy, which requires preparation and sedation. By detecting disease before it becomes apparent, clinicians are usually able to treat it more effectively — and often cure it.
Medical organizations want to be sure that screening tests are used appropriately — in people for whom they've proven most effective. Accordingly, they may conduct studies of death rates from a disease in which they compare people who've been screened for the disease with people in the same category (for example, the same gender, age group, or risk level) who have not been screened. These studies help health officials to assess whether and for which groups of people the potential benefit of a test outweighs the risks. The studies can also be used to calculate statistically the number of people who would need to be tested in order to save a life.
The United States Preventive Services Task Force (USPSTF), an independent panel of primary care clinicians established by the US Congress, is responsible for developing federal guidelines for all screening tests (see "USPSTF screening guidelines for women ages 50 and over"). Many medical specialty societies also formulate their own guidelines. For example, the American Congress of Obstetricians and Gynecologists (ACOG) publishes guidelines for Pap smears, and both the National Cancer Institute (NCI) and the American Cancer Society (ACS) make recommendations for cancer screenings. Guidelines from these other organizations don't always match those of the USPSTF, but you and your clinician should be able to reconcile the differences.
