I am intensely interested in longevity science, and my interest has increased as I age. This January, I turn 80. Aging is like climbing a mountain. Eventually, you will reach the top. It was a lot of work getting there. The view is lovely, but there is only one path ahead, and that is down. The trip will be much shorter. Friends ask why I write about mortality from time to time. I often think about it and want to share my thoughts and experiences through this journey down the mountain. 

Increasing Lifespan

Most things we can do to increase our lifespan are related to lifestyle.  For instance, exercise, diet, regular sleep, and low stress significantly extend longevity. Combining such factors can add at least ten years to the life span.  That means that those who have the right lifestyle choices can add five years to the median age of death or more, while those who have lousy lifestyle choices will have five years less than the medium.  We are at the median now, with half of those born in 1945 still alive.  You probably have another ten years on average if you are of this age. Half of those will live at least another five years after reaching 90.  None of these forecasts are taking into consideration in medical advances 

There are three aspects of health: 1)prevention, 2) diagnosis, and 3) treatment.  I will be discussing prevention.

Colonoscopy

Prevention means simply not getting an illness, and, in this case, one that could affect your mortality.  Besides lifestyle changes, some diseases can be prevented by testing and action.  Colonoscopy is a great example.  Having a colposcopy every five to ten years can reduce death from this cancer by more than 60%, from 4% to 1.2%.  Pulps (small growths on the colon’s wall) are found in about half of the procedures.  They are rarely cancerous at this stage and are removed.  In this case, a patient is recommended to have another colonoscopy in five years.  If none are found, ten years is the recommendation. By removing the polyps before they turn cancerous, the probability of having cancer is dramatically reduced.  

Let’s look at the costs.  I will say that a colonoscopy costs $2,000 to perform and that the average person would get five in a lifetime.  That means that it would cost $10,000 on average to reduce the death from colorectal cancer to 1.5% from 4%. Keep in mind that if someone does not die from cancer, they will die from something else.  So I think on average the increase in average lifespan is three months. Of course, if you were a person who would have gotten cancer, it would have a very significant impact on your life span and for the others, no impact.

This expense and the difficulties of preparing for the procedure have created great interest in alternatives. Most of these alternatives involve using stool samples. They look at the presence of blood or analyze the DNA found in the stool. Typically, they cost less than 1/3. They are not as accurate but are still within the 10% false negative range. However, they must be done more often, so they are about half the cost.

Colorectal cancer has a genetic aspect, so if there were this cancer in your family, it would be a strong indicator of the need for testing.

In the Netherlands, where I currently live, colonoscopies are rarely performed. Instead, stool tests are utilized. When we moved here, my wife received icy a test by mail without even asking for it. The government did not send one to me, I suspect, because of my age.

Why did I say final colonoscopy?  In the test I just had, no polyps were found.  My following procedure would be in ten years.  The likelihood of finding something is very low, and even if they did, the chances that I would die from colorectal cancer rather than something else are minimal.

Other Screening/Prevention

Routine monitoring for skin cancer is an easy and effective way of reducing death from this disease.  Reducing cholesterol is thought to impact heart disease significantly, but this is somewhat controversial.  Breast and prostate cancer screening can be adequate, especially the former.  I already had a melanoma that was successfully treated about 20 years ago.  I check my skin 2-3 times a year and check myself often.

Cardiovascular tests, such as Echocardiography Stress tests, can identify cardiovascular disease ( I was part of the team that developed this test in 1970s). Depending on the findings, these may lead to treatment or lifestyle modification.   I do this test every three years.

I had a CT angiogram done a few years ago to check for issues with my coronary arteries.  Having a few friends who died from “sudden death syndrome,” I wanted to make sure my arteries were clear. They are.  

The Economics of Screening

Many factors are considered when considering the economics of screening. There is a tremendous economic benefit to early detection of disease. The problem is that we have to test so many people and so often. So if it costs $1,000 to detect a disease but only 1 in 100 people test positive, the cost for that positive test is $100,000.  But then we have to consider the cost of not detecting the disease early and either having expensive treatment or the illness and death of a person. 

I can only look at it from my own personal perspective.  How much is another year of healthy life worth to me or to you?  And does that change as we age (I think for sure).  Because we are largely using population based medicine, we would have to test and treat a lot of diseases to have an increase in a year.  However, as we move into personalized medicine, we can reduce the number of tests to fit our personal probabilities. 

What does the future hold for us

Right now, we are focused on what I refer to as population-based medicine. AI will allow us to move to personalized medicine. It will tell us who will benefit from procedures like colonoscopies.   One of the key drivers will be liquid biopsy.  Using AI to analyze various information in the blood will help determine the likelihood of developing various diseases or the presence of these diseases (diagnosis) and the best way to treat them.   This is the area I am working in at the present.  I often say the blood knows it all.