Dermatologists have not established an end point, or an expiration date, when they no longer screen for skin cancer. Skin doctors recommend screening for skin cancer every 3-6 months for the entire life of susceptible adults. Adults who are pale-complected, red-haired and blue-eyed are highly likely to develop skin cancer. Dermatologists easily recognize a suspicious skin lesion, and know whether or not it needs biopsying. They also know skin cancer should be diagnosed early and treated as soon as possible, regardless of the patient’s age. Screening for skin cancer is a life-long priority.
So, if you’re that diligent about finding a type of cancer that won’t kill you, why would you decide to stop looking for potentially fatal cancers when patients reach a certain age? That’s my major question. Malignant melanomas are a different animal because they have highly malignant characteristics. Melanomas need to be screened for regularly due their aggressive nature, and this screening also has no end date.
The major question, then, deals with the “Big Five” cancers—colorectal, breast, lung, prostate, and uterine cervix—all of which have a date after which doctors don’t recommend further screening. These recommendations largely come from two sources: the American Cancer Society (ACS) and the United States Preventive Services Task Force—the USPSTF. For example, screening for breast cancer is not recommended for women over 74 years of age. PSA testing for prostate cancer is not recommended for men over age 70. Cervical cancer screening stops at age 65 for women who have had adequate previous screenings and are low risk patients. Colonoscopy for colorectal cancer is not recommended after age 75, and lung cancer screening is done for patients age 50-80 who have a 20-pack-year smoking history.
The ages chosen by these organizations are not arbitrary choices, but are well-researched, well-thought out decisions based on reams of data and clinical experience. However, most clinical studies on cancer screenings don’t include the real elderly folks—those 75 and older. To make such recommendations in the elderly there has to be evidence screening will lead to improved quality of life and greater longevity. Many patients are excluded because they are cognitively impaired, have serious co-morbidities, are poorly functional, or have a limited life expectancy. One’s longevity must be 10 or more years for the value of screening to be realized.
Another important reason for stopping screening is that the elderly are highly susceptible to complications from screening procedures. Some of these screenings carry significant risk and people with limited life expectancy place themselves at high risk when surgery, chemotherapy, or radiotherapy are employed. Sometimes the diagnostic protocol is more harmful than the primary disease itself. Quality of life is important, and cancer treatment usually makes that worse.
In my opinion, to ignore cancer screenings in the elderly, who still live independently and have a life expectancy of 3, 4, or 5 years, is negligence. These folks are still functional, not cognitively impaired, are still enjoying life, and should not be given up on because their age has reached an arbitrary number. If you’re 90, can still walk, have control of your bowels and bladder, and can remember what day it is, you’re still in good shape, and I think you’re a candidate for some cancer screenings and treatment. You should be offered definitive treatment just as if you were 60 or 65 years old, and let you decide for yourself.
The real problem I see is that no one can predict how long anyone might live. It’s an educated guess at best. I think a doctor must know his patient well enough to have a sense of who to screen and who not. If the doctor tells his 75 year old athletic patient he doesn’t need a colonoscopy, and three months later he has currant jelly discharge in his feces caused by a cancerous large intestine lesion, the doctor should apologize for discouraging screening, and the patient should be upset with his doctor. And the USPSTF should feel remorse for deciding that 75 year old Americans can let down their guard. I think that’s a mistake. Never let down your guard, because when you do, bad things happen, and earlier screening might have found them and made them treatable. I feel the age limits suggested by these agencies should be applied to screening situations on a case-by-case basis. Not everyone at 75 is ready to be put out to pasture. Many may live an additional 10-15 years. Individualization of decisions for cancer screening is something every doctor must take into consideration. While it’s very true the patient may not live any longer at age 85 if lung cancer is diagnosed, his/her family will know the doctor had the sense to do the appropriate tests to understand why he/she had declining health. That’s worth something.
Reference: Brown MM, Adams CA, Halpert KD. Cancer Screening in Older Adults Am Fam Phys 2025 December;112(6):629-
