Robie P W
Department of Internal Medicine, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, NC 27103.
J Am Geriatr Soc. 1989 Sep;37(9):888-93. doi: 10.1111/j.1532-5415.1989.tb02272.x.
Cancer screening in the elderly presents several unique challenges. There are no prospective trials of any cancer screening exam that have conclusively demonstrated efficacy in this age group. Any assessment of cancer screening in the elderly must include measuring an improvement in quality of life and functional status as well as decreased mortality from early cancer detection. Older patients usually prefer improved quality over quantity of life; they may be less interested in a trade-off of months or years of life in exchange for the side effects of cancer treatment. The elderly may need more home assistance during the treatment of the detected cancers; physicians should arrange for this. All of these variables must be included in studies of cancer screening in the elderly; the need for these studies is great. The following recommendations are probably the most reasonable in view of the currently inadequate knowledge base. Screening for breast cancer has demonstrated efficacy, with growing evidence for a cumulative effect from monthly breast self-examination, yearly breast examination by a physician, and yearly or biennial mammography. There may be no need to screen for cervical cancer in women after age 65 who have had regular Pap smear screening; however, older women who have never had Pap smears should have regular Pap smears for several years. Finally, because of the high frequency of colorectal and prostate cancers in the elderly, physicians should probably perform yearly rectal examinations with stool guaiac and regular sigmoidoscopy in this age group until definitive data support continuing or discontinuing these screening examinations. Physicians should educate their elderly patients to the importance of regular cancer screening and cancer risk-factor modification and should offer cancer screening examinations and counseling to elderly patients on a regularly scheduled basis.
老年人的癌症筛查面临一些独特的挑战。尚无任何癌症筛查检查的前瞻性试验能确凿证明在该年龄组中的有效性。对老年人癌症筛查的任何评估都必须包括衡量生活质量和功能状态的改善以及早期癌症检测导致的死亡率降低。老年患者通常更倾向于生活质量的改善而非寿命延长；他们可能对以数月或数年的生命为代价来换取癌症治疗的副作用不太感兴趣。在检测出癌症的治疗期间，老年人可能需要更多的家庭帮助；医生应为此做出安排。所有这些变量都必须纳入老年人癌症筛查的研究中；对这些研究的需求很大。鉴于目前知识基础不足，以下建议可能是最合理的。乳腺癌筛查已证明有效，越来越多的证据表明，每月的乳房自我检查、每年由医生进行的乳房检查以及每年或每两年进行的乳房X光检查具有累积效应。65岁后定期进行巴氏涂片筛查的女性可能无需再进行宫颈癌筛查；然而，从未进行过巴氏涂片检查的老年女性应连续数年定期进行巴氏涂片检查。最后，由于老年人结直肠癌和前列腺癌的发病率较高，在有确切数据支持继续或停止这些筛查检查之前，医生可能应在该年龄组中每年进行直肠指检并做粪便潜血检查，以及定期进行乙状结肠镜检查。医生应向老年患者宣传定期癌症筛查和改变癌症风险因素的重要性，并应定期为老年患者提供癌症筛查检查和咨询服务。
