Mammograms may be overused in women with dementia
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Some elderly women with severe cognitive impairment are getting mammography breast cancer screening even though they are unlikely to ever benefit from it, a new study finds.
Researchers found that among more than 2,100 U.S. women age 70 and older, 18 percent of those with advanced cognitive impairment had received a screening mammogram in the past two years.
This was despite the fact that these women would likely fall into a group that, according to guidelines, should not routinely have mammography screening.
While there is no set age at which women should stop getting screening mammograms, experts do advise that elderly women’s health be taken into account in screening decisions. For those with serious medical conditions, the risks of screening—and any subsequent invasive tests and treatments—may outweigh the benefits.
Because of this, guidelines from the American Cancer Society (ACS) and other groups state that women with a life expectancy of fewer than four to five years should not have mammography screening.
In the current study, the researchers calculated that the 355 women with severe cognitive impairment had a life expectancy of just over three years. Yet 18 percent had received a recent screening mammogram—including nearly half of those who were married and had a net worth of more than $100,000.
Among women with normal cognition, the screening rate was 45 percent.
What the study could not reveal is why some severely cognitively impaired women were still being screened, lead researcher Dr. Kala M. Mehta, of the University of California, San Francisco, said in an interview.
“It could be due to the preferences of the women and their families, or to their doctors’ preferences,” Mehta said.
But it’s possible, according to the researcher, that some doctors are recommending screening because there are no specific guidelines addressing women with dementia.
“Our data support the need for those guidelines,” Mehta said. “We think they should be more explicit about when to stop screening cognitively impaired older women.”
The findings, published in the American Journal of Public Health, come at a time when questions are being raised about which women should get regular screening mammograms.
In November, the U.S. Preventive Services Task Force, a government advisory panel, created a firestorm when it released guidelines saying that women in their 40s who are at average risk of breast cancer do not need routine mammograms. Its previous guidelines, from 2002, had called on all women age 40 and older to have a screening mammogram every one to two years—advice that the ACS and other medical groups still stand by.
At the core of the issue is the fact that while cancer screening can save lives by catching tumors early, it also has downsides. It can result, for example, in false alarms that lead to unnecessary invasive testing and anxiety, as well as treatment of small tumors that would never have grown to be life-threatening.
It is for those reasons that experts generally advise against routine mammography for elderly women in poor health and a limited life expectancy.
For women with severe cognitive impairment, there are particular issues. Many, Mehta noted, may not even understand why they are having the test, and putting them through it could cause undue stress.
In addition, she said, these women typically have many medical concerns—from poor physical health to depression to behavioral issues—that should take precedence over mammography screening.
The bottom line for families, Mehta said, is that they should understand that screening decisions need to be made on an individual basis, and for some women, the risks outweigh the potential benefits.
In contrast, she added, screening could be a good choice for a 75-year-old woman who is healthy and independent, and can expect to live for many more years.
SOURCE: American Journal of Public Health, online January 14, 2010.
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