When to Stop Screening: A Review of Breast, Gynecologic, and Colorectal Cancer Screening in Women Over Age 65

Bernstein, Rebecca; DeJoseph, Daniel; Buchanan, Edward M.

doi:10.1891/1521-0987.11.1.48

Cited by 6 publications

(5 citation statements)

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“…From a time‐to‐benefit perspective, women with a life expectancy of <5–10 years are more likely to suffer harm than benefit from screening 106. Harms of screening in older adults include false‐positives which may lead to anxiety, further testing, and finding low‐grade lesions that may not become clinically significant 106,111…”

Section: Geriatric Health‐maintenance Recommendationsmentioning

confidence: 99%

Health Maintenance in Older Adults: Combining Evidence and Individual Preferences

Gestuvo¹

2012

Mount Sinai J Medicine

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There is increasing interest in maintaining health and delaying disability for older adults as this population segment expands. And instead of focusing on a traditional disease-specific approach to health maintenance, there is an ongoing shift to a patient-centered approach, and defining outcomes based on the older adults' goals. In this approach, their goals and preferences are central, and other factors such as their health status and prognosis help determine which goals may be realistic. These subjective goals and objective characteristics are then balanced with the risks, benefits, and harms of established evidence-driven health-maintenance recommendations. Hence, older adults share their goals and preferences with clinicians; while clinicians share information on risks, benefits, harms, and uncertainties of existing health-maintenance recommendations, and help guide the older adult through how existing evidence can respond to their health goals and preferences. In this article, the concept of patient-centered care in the context of health maintenance for older adults is discussed; and health maintenance recommendations for older adults are reviewed.

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Section: Geriatric Health‐maintenance Recommendationsmentioning

confidence: 99%

Health Maintenance in Older Adults: Combining Evidence and Individual Preferences

Gestuvo¹

2012

Mount Sinai J Medicine

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“…To date, there have only been limited studies which focused on SIL in HIV-infected menopausal women. Therefore, it is not clear whether the general guidelines regarding cervical cancer screening [13, 14] should be applied to HIV-infected menopausal women.…”

Section: Introductionmentioning

confidence: 99%

Effect of Highly Active Antiretroviral Therapy (HAART) and Menopause on Risk of Progression of Cervical Dysplasia in Human Immune-Deficiency Virus- (HIV-) Infected Women

Kim

Messing

Shah

et al. 2013

Infectious Diseases in Obstetrics and Gynecology

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Background. More HIV-infected women are reaching older age and menopause, but there is limited information on cervical squamous intraepithelial lesions (SILs) on these women. Methods. To assess the effect of HAART and menopause on SILs in HIV-infected women, we reviewed the results of Papanicolaou (Pap) tests obtained between 1991 and 2011 on 245 women. Progression to SILs was determined by comparing Pap test results. The association of HAART and transition to menopause on SILs was assessed using survival analysis. Results. Women receiving HAART had a 52% reduced risk in the progression to SILs compared to women receiving any other antiretroviral regimen or no regimen (CI: 0.33–0.70, P = 0.0001). A greater increase of CD4+ cell counts was associated with a greater reduction on the risk of progression to SILs. Menopausal women had a 70% higher risk of progression to SILs than premenopausal women (CI: 1.11–2.62, P < 0.0001), adjusting for HIV medications, CD4+ count, duration of HIV infection, moderation effect of menopause by age, prior IV drug use, and smoking. Conclusion. HAART had a positive long-term effect on the progression to SILs. However, being younger and menopausal increases the risk of progression.

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“…If discontinuation of routine pap smears and pelvic exams occur in older women, routine inspection is likely not to occur. Recent guidelines are unclear on how often visual inspection examinations should now occur [ 9 , 12 , 46 , 47 ]. With a push toward more HPV focused testing, screening protocols for vulvar cancers should be further reviewed and more research conducted to determine protocols for screening older women for vulvar and vaginal cancers.…”

Section: Common Gynecologic Disorders In Older Womenmentioning

confidence: 99%

“…The most important aspect is likely taking an accurate history, performing a symptom analysis if symptoms are reported and using diagnostic reasoning to determine what, if any physical exam techniques need to be performed [ 9 ]. However, in older women, recent changes in guidelines may adversely affect the identification and treatment of gynecological disorders.…”

Section: Introductionmentioning

confidence: 99%

Factors Affecting Gynecologic and Sexual Assessment in Older Women: A Lesson for Primary Care Providers

et al. 2015

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Guidelines for screening of cervical cancer and pelvic exams for older women have recently changed. These changes may have unexpected sequelae in women over 65 years of age. This manuscript provides a review of gynecologic screening recommendations for older women in the U.S. and potential ramifications of these recent changes. Peer reviewed guidelines from the American College of Obstetrics and Gynecology, U.S. Preventative Task Force Services, the American Cancer Society, The Centers for Disease Control, and multiple original research articles and reviews were reviewed for this manuscript. Women over 65 are at greatest risk to develop late stage diagnoses of cancers, pelvic organ disease, incontinence, and infections. Clinicians will need to acutely consider this fact when communicating and screening this population. We conclude that practitioners should be aware of the new guidelines and should consider including gynecologic health history and symptom analysis as part of annual exams in women of all ages.

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When to Stop Screening: A Review of Breast, Gynecologic, and Colorectal Cancer Screening in Women Over Age 65

Cited by 6 publications

References 0 publications

Health Maintenance in Older Adults: Combining Evidence and Individual Preferences

Health Maintenance in Older Adults: Combining Evidence and Individual Preferences

Effect of Highly Active Antiretroviral Therapy (HAART) and Menopause on Risk of Progression of Cervical Dysplasia in Human Immune-Deficiency Virus- (HIV-) Infected Women

Factors Affecting Gynecologic and Sexual Assessment in Older Women: A Lesson for Primary Care Providers

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