Oncologists blame the general not to proceed with manual screening

Cancer screening is insufficient in people 70-80 years, denouncing the oncologists, who partly blame the GPs, according to them guilty of not practicing enough manual screening.

Routine screening?

Today, the taboo associated with the nakedness of older people is deeply rooted in our society. Number of GPs are uncomfortable when it do a strip-old patient and in addition an old woman and perform a manual review, and passing by small tumors easily detectable.

Therefore, screening for breast cancer in women over 70 years is very low, resulting in delayed diagnosis, while its incidence increases with age, it is a rapid and Early diagnosis of halting its progression, lamented Dr. Francois Pein, Institut Gustave Roussy (Villejuif), during a session on cancer after 70 years, organized under Eurocancer.

For the oncologist, "GPs must undress their patients, especially if they are older." Deliberately provocative, he called his general practitioners to "reach into the bra" their elderly patients and conduct a pat of their breasts.

Same for prostate cancer, whose incidence increases with age, but for which there are no recommendations for mass screening in over 70 years. For Professor Jean-Pierre Droz, oncologist at the Centre Léon Bérard in Lyon, a man aged 70-75 years, diagnosed with prostate cancer, which also presents no criteria for frailty, may well undergo prostatectomy.

A very heterogeneous population

In general, older people do not benefit from the multidisciplinary consultation enjoyed by younger patients, and for them, the recommendations are poorly monitored, confirmed Professor Dominique Maraninchi, oncologist at the Institut Paoli Calmettes in Marseille .

However, with the increase in life expectancy, the average age of cancer patients will soon reach or exceed 70 years against 60-65. Those 70 years have 19 more years to live, and those aged 80 7.7. It should therefore not neglect this population and make sure to give them the means to a good quality of life during their last years of life.

"From a certain age, it is not the quantity of survival he must aim, but the quality," rightly pointed out by Pein, activist compliance and maintaining autonomy elderly patients.

The specialist also denounced three ideas that explain the delay or absence of screening, diagnosis and treatment, relief or sometimes "irrational" of it: the cancer progresses slower in the elderly, these are fragile, making it less effective and more toxic chemotherapy, and finally they do not want their cancer is treated. "This is all wrong!" Is he exclaimed.

In contrast, the geriatrician population is very heterogeneous, it recommends to classify elderly patients into subgroups according to their degree of autonomy, and customize the treatment plan for each. Indeed, autonomous patients without comorbidities can quite successfully support healing therapies, while the frail elderly and other diseases dependent may receive only palliative care.

"Chronological age is not a relevant factor in the decision," added Professor Claude Jeandel, a geriatrician at the University Hospital of Montpellier, for whom the only issue that the doctor must ask is to what category is his patient.

Therefore plebiscite approach based on the concept of functional reserve, "what matters is the ability of a person to cope with a stressful event" ... but still recognizes the lack of tools to measure this ability.

Oncologists present finally denounced the lack of representation of older patients in clinical trials, as they are ultimately the main users of developed drugs. With "too much risk of complications," the "orphans of the system," as he called Dr. Pein, "could penalize an authorization file on the market."