Screening

Doctors are best able to treat cancer when it is found early. However, in early stages, cancer rarely causes symptoms, making it difficult to find cancer early. Early diagnosis of cancer is helped by regular screening. Screening in older people is often different in terms of benefits and risks. Little may be gained from detecting a slow-growing cancer that would never cause harm within the person's predicted life expectancy. Moreover, the screening procedures and any additional tests and treatments may carry risks without benefits.

Types of screening tests vary, depending on the cancer. Some simple self-screening measures can be carried out, with the assistance of a family member or friend if necessary. For instance, to check for colon cancer, a person can collect small samples of stool on special cards, which are then sent to a health care practitioner and analyzed for the presence of blood. A woman may be able to detect breast cancer at an early stage by examining her breasts monthly (although regular breast examination by a doctor and mammography are also needed). Regularly examining the skin can help detect skin cancer. However, because most people cannot see all of their skin, help from a family member or friend should also be sought from time to time, and a doctor should perform an annual total body examination. This way, areas that are difficult to see, such as the back, can be checked.

In general, doctors recommend that older people be screened for several types of cancer. For some cancers, such as those of the breast and colon, screening has been proven to reduce the risk of dying from that cancer. However, screening is not as effective for all cancers, and experts disagree about which people benefit most from some screening tests. For example, many experts agree that older men should have regular rectal examinations to test for prostate cancer and rectal cancer. By contrast, the prostate-specific antigen (PSA) test is controversial. Sometimes the PSA level in the blood is elevated in men with prostate cancer, but the PSA level can also increase in men with a noncancerous condition called benign prostatic hyperplasia, and it may be normal in men with prostate cancer. Moreover, screening may not reduce the risk of older men dying from prostate cancer. Thus, PSA screening is commonly omitted in men whose life expectancy is less than 10 years (due to their age and the diseases they have).