Screening in Older Adults
Cancer Screenings in Adults 65+ (AGS Guide)
- Consider a patient’s remaining life expectancy, comorbidities, risk of disease, preferences, cognitive and functional status when deciding which preventative measures to offer.
- Cancer screenings below are not recommended for older adults with at least moderate dementia or those near the end of life
- Older adults are generally open to conversations about stopping cancer screenings, especially when coming from a physician whom they trust.
- Work by Nancy L. Schoenborn recommends framing these conversations around age, health status, and helping people live longer but showed discussing life expectancy in this context can be controversial.
- Most compelling reason to stop screening: “this test would not help you live longer” instead of “you may not live long enough to benefit from this test”
- UCSF Time to Benefit Calculator can help determine which interventions could potentially benefit or harm your patient
Resource: UCSF ePrognosis Score https://eprognosis.ucsf.edu/time_to_benefit.php
Screening (Malignancy) |
General Cessation Guidance |
|---|---|
| Mammogram (every 2 years)* | Consider at age 75 |
| Pap Smear* | Stop at age 65, Continue screening after 65 if: inadequate prior screening, history of CIN2+ in past 25 years, history of cervical cancer, or immunosuppression. |
| Colon Cancer* |
Shared decision-making ages 76-85 Stop at age 86 |
| Lung Cancer (annually in those at risk) | Stop at age 80, stop if has not smoked in 15 years or develops a life limiting health condition |
| Prostate Cancer* | Stop at age 70 (if patient previously preferred screening) |
*Not recommended for persons with < 10 years remaining life expectancy
Screening (non-Malignancy) | General Cessation Guidance |
|---|---|
| DEXA* |
-At least once after age 65 in women or <65 if high risk -USPSTF: DEXA scans do not have upper age limit and can continue as long as patient is healthy enough to undergo fracture treatment and results would change management |
| Blood Glucose* |
-Consider stopping at age 70 -Not recommended for persons with <10 years remaining life expectancy |
| Cholesterol* |
-Screen up to age 75 -Consider if life expectancy 5 to <10 years |
| Abdominal Aortic Aneurysm* |
-Once for men 65-75 who ever smoked (100 cigarettes lifetime) -Can consider in men who never smoked, selectively in healthy men >75 who smoked and were not previously screened -Consider if life expectancy 5 to <10 years |
| HIV | -Consider for those at high risk or once from ages 15-65 |
| Hepatitis B | -Consider for those at high risk |
| Hepatitis C | -Once ages 18-79 or consider for those at high risk |
*Not recommended for persons with moderate dementia
Please see outpatient medicine section for Immunization guidelines