Perspectives in cancer screening in the elderly.

The concern is whether physicians and the health care system make cancer screening available to the elderly. This question has special meaning in this population as it is apparent that problems in screening for cancer have not been addressed. First, primary care physicians do not emphasize cancer prevention and early diagnosis in the elderly. Second, there is a need to educate the American population about cancer prevention, methods of early diagnosis, and the problems and realities surrounding cancer. The elderly are less aware of and use significantly fewer of the available screening resources. When this is coupled with a health system that does not provide funding for preventive and screening services (Medicare, Medicaid, and most third-party insurance carriers), the potential to deal with this problem becomes extremely difficult. High-quality primary care is the key to cancer screening in the elderly. The physician must take responsibility for health promotion while concentrating on screening. Two good rules of thumb are 1) to screen all patients for cancer and other diseases on a routine basis based upon screening recommendations in the current literature; and 2) to evaluate a normal patient who comes to the physician with a complaint (to assure early diagnosis). It is difficult to decide when an aggressive work-up is needed since older patients are at risk of complications from diagnostic procedures. The elderly are singularly under-represented in most studies of screening and prevention. We are therefore left with the reality that, no matter what set of recommendations is put forward, the physician is acting from incomplete information. The published guidelines are not directed at the elderly. Omission of the elderly from these studies leaves unknown the risks, benefits, and even the actual ability to screen. There is a need for better screening methods. There is evidence in the literature that both the physician and the patient need to be educated. The need for research in screening efficacy is coupled with a need to define methodologies to educate the provider and the patient and to determine how to reach high-risk populations. In the interim, the implementation of the guidelines discussed, with consideration of the current literature, is recommended to the physician as a rational approach.