By Diane Archer
Medicare covers a wide array of preventive care services, which can offer tremendous benefits. But, some preventive care services may cause more harm than good for people, especially those who are older. Liz Szabo reports for Kaiser Health News on when to avoid preventive care services.
Mammograms and cervical cancer screenings
Experts say that people with terminal cancers of the lung, colon, and pancreas generally should not be getting a mammogram or cervical cancer screening. Similarly, people in their late 80s and older with multiple chronic conditions usually do not need these services. The risks of harm outweigh the benefits.
Experts further say that people with severe dementia and other chronic conditions near the end of life also do not need mammograms — a mammogram will not improve their quality of life and may lead to unnecessary surgeries. It might also result in painful hormonal therapies that can increase risk of stroke. Moreover, a mammogram is unlikely to identify a deadly disease.
The research shows that only 1 woman in 1,000 who gets a mammogram over a lifetime does not die because the cancer was detected before it spread. 64 of those 1,000 women will get biopsies, which generally involves cells withdrawn through a needle, for nonthreatening lumps. 10 of the 1,000 will get unnecessary treatment — most often radiation and surgery — for lumps that would never have caused a problem. All of the women who get unnecessary treatment will also go through the emotional impact of being told they might have cancer when they don’t.
Prostate cancer screenings
Experts also say that older people who already have a deadly cancer or who are at grave risk of dying within 10 years are not likely to be helped by prostate-specific antigen (PSA) tests. Such tests tend to identify tumors that are extremely slow-growing and do not need to be treated. And more than 2 in 3 prostate cancer screenings find something that does not need to be found.
The follow-up biopsy causes infections in about 6% of men, 1% of whom end up in the hospital. These screenings have been deemed “low value” in men 75 and older. Research shows that men who receive surgery or radiotherapy for prostate cancer are no more likely to live 10 years than men who receive active monitoring.
Colonoscopies can lead to intestinal tears. And, people 75 and older are more likely to get a tear than younger people. Colonoscopies can also lead to dehydration and fainting in older adults.
Skin cancer removal
People in their late 80s and older also might want to avoid removing skin cancers that are not life threatening. Caring for the skin after the cancer is removed can be problematic, and wounds may not heal: More than 25 percent of people report problems with their wounds healing.
In sum, if you are wondering why some people should avoid these “harmless” tests, it is that the tests can lead to false positives, stress, and unnecessary invasive procedures as well as medical complications.