Is it worth it for your elders to get cancer screening? Risks that doctors don’t tell you about

Harold Honeyfield, 88, had surgery for prostate cancer 13 years ago, which left him with permanent impotence, a big regret for him and his 48-year-old wife. Honeyfield said he did not know the risks of the surgery beforehand, and although the disease was cured, “a man who cannot have an erection is equivalent to being paralyzed.”

Honeyfield’s experience is not an isolated case. A 2013 study in the Journal of the American Medical Association Internal Medicine (JAMA-IM) found that 14% of men who had prostate cancer surgery had bladder weakness and 14% had erectile dysfunction. Dr. Richard Hoffman of the University of Iowa Carver College of Medicine found that most prostate cancer patients who did not understand the risks before surgery regretted the treatment.

In fact, prostate cancer is a slow-growing cancer, and many prostate cancer patients do not eventually die from prostate cancer, so even if you have prostate cancer, you may not need treatment. Studies in the United States and Europe have found that PSA (prostate-specific antigen) tests cannot reduce the mortality rate of prostate cancer, and subsequent puncture tests or treatments are likely to cause sequelae such as impotence, urinary incontinence, and difficulty defecating. Therefore, health and medical units in the United States, Europe, Australia, Japan and other countries do not recommend large-scale PSA screening.

Are seniors suitable for cancer screening?

Many countries have medical insurance or subsidies for the elderly. For example, in the United States, people over 65 years old are covered by Medicare, and Taiwan is covered by the National Health Insurance. In the United States, some cancer screenings have become a medical culture under active promotion. Many people have done it from middle age to old age, and screening has become a habit.

However, medical research shows that patients and doctors are very enthusiastic about cancer screening, overestimating the benefits and underestimating the risks. More and more geriatricians and oncologists are calling for such tests to be almost impossible to detect serious diseases and may do more harm than help because follow-up examinations and treatments are often invasive.

According to a report in the American Journal of Public Health (AJPH), nearly one in five women with severe cognitive impairment still get regular mammograms, and studies have shown that 55% of older men at high risk of dying within ten years still get PSA screening.

Experts do not recommend such tests for people with a limited amount of time left. Cancer screenings in people in their 70s and 80s often reveal slow-growing tumors that are unlikely to cause problems in their remaining years, especially prostate cancer, which is usually harmless, said Deborah Korenstein, chief of medicine at Memorial Sloan-Kettering Cancer Center in New York. These patients often die of other causes (dementia, heart disease or pneumonia) before the cancer becomes a threat.