Screening tests such as Pap smears and blood pressure checks can save your life. You may not be aware of a condition that you are likely to have. Early detection can allow for treatment before irreversible complications occur.
Some screening tests can help detect the disease they are meant to see. For example, colonoscopies and Pap smears can detect precancerous abnormalities and help stop them from growing and becoming cancerous. Missed screening tests contribute to the US’s thousands of preventable deaths every year. A new study on Pap smears shows that there is a point where the returns are diminishing. Many of us would benefit from a better understanding of the limitations of screening and how experts determine when routine screening should be stopped.
Know the limits of screening tests
Every screening test could be better. False-negative results can cause it to miss the disease it intended to detect. It can also return abnormal results if no condition exists (false positive results).
Significantly, screening benefits decrease as people age, and their life expectancy falls. Routine screenings can miss many conditions, including cervical cancer and prostate cancer. In their 80s, a person is more likely than ever to be diagnosed with prostate cancer or another severe illness. As we age, certain diseases like cervical cancer become more common.
Many screening tests are only sometimes recommended. Your doctor might tell you that you don’t need another screening test, even if you feel you’ve gotten used to it.
Find out when screening tests end.
Many screening tests have an “end age,” which is the point at which people can stop taking them. Experts recommend this. Take, for example:
- Pap smear: age 65
- Mammogram: Age 75
- colonoscopy: age 75
- Chest CT scan (recommended to people who have a history of significant smoking): Age 80
Of course, there are exceptions. If a colonoscopy finds abnormalities in a 72-year-old healthy individual, repeat testing may be recommended after 75 years.
After guidelines suggested stopping, many women get Pap smears.
Pap smears are used to screen for cervical cancer. New guidelines suggested that women should have Pap smears at the appropriate times before they reach 65 . This would allow them to stop safely.
According to a study in JAMA Internal Medicine, many women still have this screening even after they turn 65. The study examined data from 15-16 million women annually between 1999-2019. They were all enrolled in Medicare, and most of them were 76 years old.
The study revealed:
- Nearly three million 65-year-old women had Pap smears in 1999 (roughly 19% of the population). Pap smears had dropped to 1.3 million (8.5%) by 2019, a decrease of more than half.
- About 3% of women over 80 had Pap smears.
- The cost of Pap smears for older women in 2019 was $83.5 million.
Some of the women in this study possibly had good reasons for continuing to have Pap smears. They may need to be adequately screened as children. They may have had Pap smear abnormalities in the past. Perhaps their doctors advised them to continue getting Pap smears despite being older. This information was not collected in this study. Some, if not all, of these Pap screenings, are routine testing without much benefit.
What is the point of overscreening?
Overscreening may cause
- Some discomfort may be acceptable if there is an expectation of benefits, but it will not be tolerated if the test is incontinence.
- Anxiety while you wait for the results
- False-positive results can lead to unnecessary testing and treatment
- Testing has many complications, such as bleeding or infection after a Pap smear or perforation after a colonoscopy. (Fortunately, complications are infrequent.
- Unnecessary costs include lab fees and medical appointments. This can lead to wasted time and take away valuable care from health professionals.
The bottom line
Screening tests are usually performed on people who have no symptoms or signs. They may be looking for a condition that is unlikely to exist. We have screening guidelines backed up by data and developed by experts for most screening tests.
