When Screening Tests are No Longer Called For

The guidelines for when women should have screening mammograms was recently in the news again, when the American Medical Association recommended that regular testing for women with no known risk factors should not start until age 45, rather than the age of 40, which is the current recommendation of the American Cancer Society.

The limitation that I never see in the news is that the American Cancer Society has long recommended that the annual screenings not be ordered for women over the age of 80.

By that age, any tumor would probably grow so slowly that the risk of an octogenarian  dying of breast cancer is too small to justify not only the cost of the mammogram but also the  discomfort caused by the exam and the stress of a possible cancer diagnosis

Nevertheless, I have had to intervene on behalf of my nonagenarian mother to remind her primary care physician that she will not be scheduling a mammogram per his recommendation.  I do not know whether ordering that test is on autopilot for his female patients, or because Medicare’s fee for service method of payment encourages doctors to order all the tests they can possibly justify, but either way, it doesn’t make sense for her to submit to the scan.

Screening tests are also inappropriate for a severely demented patient, or anyone who has signed a DNR due to a terminal condition.  Yet I have also had to intervene on behalf of clients who meet those descriptions, but for whom similar tests have been scheduled.

I applaud the changes to Medicare that were included in the Affordable Care Act that allow patients who need them to undergo several standard screening tests at no out-of-pocket cost.  But this doesn’t mean that doctors should continue to order them when any potential benefit is significantly outweighed by the potential for personal stress and discomfort.



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