Questions on Physical Exam & Preventive Services

Dear Dr. Spence,
I am 79 years old and have not had a physical exam in quite a while. What sort of preventive services can you recommend?
Signed,
Gertrude

Dear Gert,
Guidelines for preventive care have been determined by the United States Preventive Services Task Force (USPSTF) who has set up specific screening protocols for physicians to follow. They, of course, are merely recommendations and individual discussions should be held between patient and physician. Unfortunately, most of these guidelines do not take into consideration those patients older than 75, therefore some of the recommendations are extrapolated out based on available data. BREAST CANCER: The USPSTF recommends that women begin Pap screening within three years after the start of intercourse and no later than age 21. Further, once a woman reaches the age of 65 (unless she is at high risk), screening may cease. As mentioned in a previous article, Pap screening can be extended out to once every three years if the patient has had three consecutive negative annual exams. COLON CANCER: Screening should begin at age 50 and generally should be performed every 10 years thereafter if full colonoscopy is the screening method used. Some trials suggest that a life expectancy of at least five years is required before screening benefits are appreciated. In other words, screening of the oldest old may not be advisable. One study detected invasive cancer in 5% of 157 patients screened (all patients involved in the study were older than 85). Those confirmed to have cancer were symptomatic and had either blood in the stool, abnormal physical exam findings, or anemia. Thus, in the much older patient, perhaps we should only screen those with certain red flag symptoms. This is not the case in younger patients in whom most cases of cancer are detected in those without any symptoms at all. CARDIOVASCULAR DISEASE: CVD is the leading cause of mortality in the United States and causes 50% of all deaths in those 85 years of age or older. All patients should be screened for hypertension and hypercholesterolemia given the prevalence and associated risk. Recent studies suggest that treatment of high cholesterol in the elderly can still provide dramatic reduction in risk of cardiovascular death, assuming the patient has good general health otherwise. OSTEOPOROSIS: About one half of all postmenopausal women over the age of 50 will suffer an osteoporotic fracture in their lifetime. Women age 75-79 have a 14 fold greater risk for osteoporosis than those ages 50-54. The USPSTF recommends screening of all women greater than 65 years of age or older than 60 if that patient is at high risk. Interestingly, no specifics surrounding screening in men have been delineated, though there still appears to be an inherent risk as a man ages.

Do you have any medical questions or concerns that you would like addressed? You can contact Dr. Spence by email at panhandledailydose@hotmail.com or by mailing your question to Daily Dose, P.O. Box 6107, Marianna, FL 32446.