Seniors face conflicting advice on cancer tests

CHICAGO — Arthur Cohen was a healthy, active 85-year-old when his Toronto doctor recommended a colonoscopy to check for early signs of colorectal cancer.

The colonoscopy — Cohen's first — revealed two polyps. During surgery to remove them, the elderly man's colon was perforated and a cascade of complications followed. Cohen developed sepsis, peritonitis and kidney failure and stayed in intensive care for a full month.

Of course, most colonoscopies go smoothly, for older as well as younger adults. Still, Cohen's son Carl, of Skokie, Ill., wonders about his dad's decision to have the procedure. "It never occurred to him that he could suffer a major quality-of-life setback," Cohen said.

As the baby boomers prepare to join the 65-plus set over the next decade, medical experts are weighing the benefits and costs of cancer screenings for seniors. Mammograms for women in their 80s, colonoscopies for men and women 75 and older, and PSA (prostate specific antigen) blood tests for older men are especially controversial.

The purpose of screenings is to detect cancer early, when treatments are most likely to be effective, and to save lives. That the tests do so for colon, breast and cervical cancer has been well-established for middle-age adults but is not indisputable for those who are older, as most studies have been done in people younger than 65. Research on routine PSA screening has yet to prove a definitive benefit at any age.

On the other side are the potential costs, which can include unnecessary treatments for cancers that never would have become life-threatening, the anxiety and distress associated with cancer diagnosis, the complications associated with screening procedures or therapies, and medical expenses.

Take colon cancer. Although detecting a polyp is advantageous at age 50, the benefits are less clear at 80. Typically, polyps take 10 to 15 years to become cancerous and potentially life-threatening, and often seniors will die of other ailments before it happens, said Dr. Neal Persky, a geriatrics specialist at the University of Michigan.

But the idea it may not be advisable for older adults to undergo cancer screenings is much debated.

Some experts argue there shouldn't be firm age cutoffs because seniors aren't all alike. Some 80-year-olds are robust and can easily live another dozen years, while others have very limited life expectancies, experts said.

"As long as a person is in good health and would be a good candidate for treatment, then they are a reasonable candidate for screening," said Robert Smith, director of cancer screening at the American Cancer Society.