From the Guidelines
For a 72-year-old female with recent unintentional 20-pound weight loss, routine cancer screening should be performed along with additional evaluation for the weight loss, including mammography, colorectal cancer screening, and cervical cancer screening if she hasn't had adequate prior screening, as recommended by 1.
Recommended Cancer Screenings
- Mammography: Although the USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years or older 1, the most recent guideline from 1 suggests that regular mammography may also be carried out in women 70-74 years of age. However, for a 72-year-old, the decision should be individualized based on health status and life expectancy.
- Colorectal cancer screening: The American Cancer Society recommends annual fecal occult blood test (FOBT) or fecal immunochemical test (FIT), flexible sigmoidoscopy every 5 years, or colonoscopy every 10 years for men and women aged 50 years and older 1.
- Cervical cancer screening: Women aged 70 years who have had three or more normal Pap tests and no abnormal Pap tests in the last 10 years may choose to stop cervical cancer screening 1.
Evaluation for Unintentional Weight Loss
The unintentional weight loss requires prompt investigation beyond routine screening, as it could indicate underlying malignancy or other serious conditions. This evaluation should include:
- Comprehensive history and physical examination
- Complete blood count
- Comprehensive metabolic panel
- Thyroid function tests
- Urinalysis
- Chest X-ray
- Age-appropriate cancer screenings Additional tests like CT scans of the chest, abdomen, and pelvis may be warranted depending on initial findings. Unintentional weight loss of this magnitude (approximately 10% of body weight) in an elderly patient is concerning and should not be attributed solely to aging, as it could be the first sign of cancer, gastrointestinal disorders, endocrine problems, or other systemic diseases requiring timely diagnosis and treatment.
From the Research
Recommended Cancer Screenings
For a 72-year-old female with unintentional weight loss of 20 pounds, the following routine cancer screenings are recommended:
- Age-appropriate cancer screenings 2
- Complete blood count 3, 2, 4
- Basic metabolic panel 3, 2
- Liver function tests 3, 2
- Thyroid function tests 3, 2
- C-reactive protein level 3, 2
- Erythrocyte sedimentation rate 3, 2, 4
- Lactate dehydrogenase measurement 3, 2, 4
- Urinalysis 3, 2
- Chest radiography 3, 2
- Fecal occult blood testing 3, 2
- Abdominal ultrasonography may also be considered 3, 4
Additional Diagnostic Tests
Further imaging and invasive testing may be considered based on initial evaluation 2. If the initial evaluation is unremarkable, a three- to six-month observation period is recommended with follow-up based on clinician and patient preferences 3, 2.
Importance of Diagnostic Approach
A clinical approach, including routine laboratory tests and abdominal ultrasonography, seems to be appropriate for detecting the majority of cases of cancer among patients with isolated involuntary weight loss 4.