LIFE IS A SERIES OF STOP AND GO QUESTIONS.

I have never been a fan of separating intervals of life into passages. Rather it is more easily broken up into periods defined by relevant stop or go questions of life. Life from the first cry to age twenty-five or so is impacted by stop questions for development. There are many depending upon your culture but these questions play role for most growing Americans. Parents ask: 1. When do you stop breast-feeding? 2. When do you stop walking a child to school or waiting at the bus stop with him? 3. When do you stop cleaning up his room? When do you stop being a parental chaperone at the school dances? When do you stop arranging family summer vacations without asking what the children are already planning? When do you stop fixing up and stocking the childs college rooms to suit your preferences? After some life at home and some education, life is a phase of go questions. That is why they call it commencement. From age twenty-five to sixty-five, you are on your own and life is dictated by how you answer these questions for yourself. 1. Do I go for more education? 2. Do I marry that brainiac or the girl with the long legs? Do I stay single for good while? 3. Do I take a job offered now or do I take a longer road to the top? 4. Do I go to the doctor for regular check-up and screening tests or do I wait to see if I get sick? This go question is particularly important because we know that screening for breast cancer, colon cancer, and prostate cancer on a scheduled basis between the ages of forty and seventy- something will save lives and allow you to enter a new stop questions phase of life. After age sixty-five, the leading questions are: 1. When do I stop working? 2. When do I stop thinking? 3. When are the children coming to visit? 4. When do I stop going to the doctor for regular cancer screening exams? 5.When do I stop living? The last two are related. As life expectancy and quality of life at each decade improves for the baby boomers, the medical community has been struggling with stop questions 4 and 5 just as the business community has been wrestling with question number 1. As more and more people live and function into their nineties, the question of screening for cancers must be based upon several issues. While cancer risk may rise with age, a positive test may not reduce duration or quality of life. After age eighty, three out of every four men may develop a small or even greater prostate cancer. Because the tumor is slow growing, may not impact quality or duration of life and treatment may have adverse effects, screening for prostate cancer may cease at age seventy-five. Similarly, if a person has been screened for colon cancer before age seventy-five and results have been negative, there is no requirement to continue screening after age seventy-five. In addition, because of the risks of colonoscopy, the United States Preventive Services Task Force also states that after age eighty-five, no one should be screened. That is a clear stop order from Uncle Sam. These recommendations did not come off Funk and Wagnells back porch but are based upon review of the world literature and a computer simulation that integrates data on mortality, screening techniques, screening intervals, and stop and go ages for screening. For breast cancer, the simulations are not so clear and there is as yet no stop age for mammography. To my mind there are some questions regarding when to stop screening for colon cancer. Is the medical Task Force saying,  Stop screening because you will die soon enough from something else. Or is it saying, The odds of living the rest of your life without developing this disease are quite good. The problem is that the healthier you are and the longer you live after age seventy-five, both the pessimistic first implication and the more optimistic second interpretation become less accurate. Why is that? There is an abiding rule of life that constitutes for me the final stop and go phase of existence. The longer you live, the longer you will live. If you make it well to age eighty-five, the odds are good that you will live to be one hundred. Also if you live to age eighty-five, there is a very good chance you will not die of heart disease. (Most die between ages sixty and seventy). Cancer then is the real risk. The Task Force computer models suggest that you should stop screening for colon cancer at age seventy-five and certainly at age eighty-five. If the eighty-five year old man comes into my office and is a tad unhappy about missing his tennis match, bike ride, or golf game, I will be the last man to tell him he will die soon enough from something else or that in the next decade and a half of good life he wont develop colon cancer. Both would be statistically inaccurate. So, what to do? The healthier you are, the more you need screening at any age. Dont stop living life to the fullest. You dont know when it will stop.

Dr. Nicholas Costrini writes regularly for the Savannah Morning News and may be reached at ncostrini@georgiagi.com.