When can seniors stop shots and screenings?
As we get older, we start thinking about the benefits versus the risks of certain health screenings and vaccines. After all, our health risks change with age and life expectancy is waning. (Sorry to be so blunt, but at 70 you have fewer years ahead of you than you have behind you!)
To complicate matters even more, recommendations from organizations like the American Cancer Society, the independent U.S. Preventive Services Task Force (USPSTF) and the Centers for Disease Control and Prevention are continuously changing as research evolves.
Here's a roundup of their latest recommendations.
When can you stop vaccines? Never! Our immunity diminishes with age, so we actually need more boosts than fewer. The current recommendation from the USPSTF is that everyone 65 and older be up to date on these immunizations:
• COVID-19 vaccine
• Flu vaccine (influenza)
• Pneumococcal vaccine (pneumonia)
• Shingles vaccine (zoster)
• Tdap (tetanus, diphtheria, and whooping cough) or Td (tetanus and diphtheria)
Flu and pneumonia shots are annual. It's likely that COVID-19 shots will follow a similar pattern, with updated formulas in response to new strains. Tdap and Td are good for 10 years, and two doses of the shingles vaccine confer a decade or more of immunity.
As it usually a slow-growing cancer, it's likely that a man who develops prostate cancer late in life will die from something else. The USPSTF recommends men stop regular screenings for the prostate-specific antigen (PSA) after age 70.
However, this is an individual decision based on family history and other risk factors. For example, Black men are 50% more likely to get prostate cancer and are twice as likely to die from it. Researchers think genetic and socioeconomic factors are at play, but they haven't found a specific reason. It's recommended that Black men be screened more proactively.
If you're past 70 and trying to decide whether to be screened, answer these two questions: If the PSA level is elevated, would you agree to a biopsy? And if the biopsy revealed cancer cells, would you want immediate treatment? If you answer "yes" to both, a prostate cancer screening might be a reasonable choice. As always, talk to your health care provider.
The latest recommendation is for women to start annual breast cancer screenings at 40, but when can you reasonably stop them? Research shows only a modest improvement in longevity for women 65 and older, but everyone knows someone who says a mammogram saved her life.
Today, the recommendation is for a woman with average risk to continue mammograms as long as she's in good health and expected to live 10 years or more -- especially important for Black women, who die from breast cancer at a higher rate than white women.
Again, it's an individual decision based on family history and other risk factors, such as genetics.
There's some evidence that continuing mammograms may lead to unnecessary procedures and treatments for cancers that pose little danger late in life. If you decide to stop annual or biannual mammograms, be sure to perform self-exams monthly and report changes to your doctor right away.
Colorectal cancer screenings
For people at average risk for colorectal cancer, the American Cancer Society recommends starting regular screening at age 45 and continuing through age 75. Between the ages of 76 and 85, talk to your doctor about whether continued screenings make sense. People 85 and older no longer need colorectal cancer screening.
As with other cancers, African Americans are at greater risk. Blacks are about 20% more likely to get colorectal cancer and about 40% more likely to die from it than most other groups.
Women over age 65 who have had regular cervical cancer tests in the past 10 years with normal results need not be tested further. Those with a history of a serious cervical pre-cancer should continue to be tested for at least 25 years after diagnosis, even if testing goes past age 65.
Lung cancer screenings
The USPSTF recommends annual screening for lung cancer with low-dose computed tomography (LDCT) in adults 50 to 80 years of age who have a 20 pack-year smoking history (in other words, two packs a day for 10 years) and who currently smoke or have quit within the past 15 years.
Screenings aren't recommended for nonsmokers, but as lung cancer is caused by environmental hazards and secondhand smoke, nonsmokers should be alert to symptoms and report them to their doctor.
Science is never finished, so there's no guarantee these recommendations won't change tomorrow. Still, when it comes to managing the risks and benefits of health screenings, it's good to have the facts.
• Teri Dreher is a board-certified patient advocate. A critical care nurse for 30+ years, she is founder of NShore Patient Advocates (www.NorthShoreRN.com). Meet Teri at the first Patient Advocacy conference, open to the public, to be held on June 16 at Abbington Distinctive Banquets in Glen Ellyn. https://northshorern.com/pac. Teri is offering a free phone consultation to Daily Herald readers at (847) 612-6684.