Cancer Screening Over 70

Cancer Screening Over 70

By

Leonard Zwelling

https://www.wsj.com/opinion/dying-to-save-money-on-healthcare-joe-biden-prostate-cancer-diagnosis-screening-698c827e?mod=opinion_trendingnow_article_pos2

In this article on The Wall Street Journal’s website on May 25, Allysia Finley makes the case I would make about cancer screening in people over 70. The reason for her focus here is, of course, President Biden’s diagnosis of stage 4 prostate cancer after having had no PSA screening for over 10 years, presumably because the U.S. Preventative Services Task Force does not recommend such screening in men over 70. As far as I can tell, the USPSTF is largely made up of prevention strategists and not cancer doctors. I prefer to consult with oncologic specialists for my cancer screening. Why? In two words, President Biden. I don’t want what happened to him to happen to me.

I get that the USPSTF has to make decisions influencing the care of populations of patients taking into account risks, benefits, and costs, but medicine is not practiced on populations. It is practiced one patient at a time and, currently, my one patient is me. I want the screening because if my PSA goes up, and it has, I want the MRI (I had this and it is unpleasant as they put probes in places probes should not go), and if that shows something, I want it biopsied, and if that is positive, I think I ought to be treated. But, more importantly, I would confer with my internist and my urologist (at MD Anderson) as to the best course of action. That’s pretty much how I have done it for the past ten years or so and I am way over 70.

In Ms. Finley’s article, she quotes the prominent Democratic physician Zeke Emmanuel as saying he wants to be dead at 75, because he will have significantly deteriorated by then, and does not wish to live without his full faculties.

I will be 77 in July. I am not ready to die despite the fact that I can no longer walk all that far. I still exercise every day. I can read and write. Some say I write better now than when I was at Anderson and was much younger. I can do The New York Times Sunday crossword puzzle. I’m not dead yet.

But mostly, I want to decide how I wish to be cared for and not have some group of non-oncologists dictate how I will be screened for cancer. That’s something I decide with my doctors.

If Dr. Emanuel is ready to die at 75, that’s his choice. It obviously was not mine.

I am of the belief that President Biden is the victim of blatant malpractice. He should have had a yearly PSA blood test. If he had had the test, it is likely that he would have been diagnosed with disease limited to his prostate and had some form of local therapy and might never had had metastases to his bones, a painful complication of stage 4 disease.

On our podcast, A New Prescription, my son Andrew and I will be interviewing Dr. Terry Bevers of MD Anderson, a true expert in cancer screening. Without giving away what we will discuss, her approach is risk-based. People have different risks of cancer based on their family history, associated genetics, and co-existing medical conditions. Dr. Bevers uses a patient’s individual risk to determine his or her required screening.

Mr. Biden’s risk five years ago, is my risk now, as far as I know. I choose to get biannual PSA tests in association with my risk as assessed by my oncologic urologist. It is simply hard for me to believe that my medical care is better than that of the President of the United States.

But, I believe it is.

Oh, by the way, my internist administers a cognitive screening test to me every year as well. It’s quick. It tests my short-term memory to recall three words and to reproduce a picture that people with dementia cannot draw. I wonder if Mr. Biden had one of those recently. I wonder if he passed.