Tuesday, 8 July 2008
Mammography screening of the elderly - controversies
Last month a paper was published in the Journal of Clinical Oncology entitled - Mammography Before Diagnosis Among Women Age 80 Years and Older With Breast Cancer from MD Anderson Cancer Center in Texas.
The study found that among those who had a mammogram every year or two before their diagnosis, 68 percent found the cancer at an early stage, compared with 33 percent of those who skipped mammograms altogether.
Their conclusion was that regular mammography among women > or = to 80 years of age was associated with earlier disease stage, although improved survival remains difficult to demonstrate. Health care providers should consider discussing the potential benefits of screening mammography with their older patients, particularly for those without significant comorbidity.
This sparked coverage by the New York Times, which did a good job of presenting the pros and cons of screening the elderly. Considering that the end point for measuring a screening program is mortality reduction, then it should be looked at in a proper light rather than just concentrating on reducing morbidity from the disease.
We have the occasional patient in San Francisco having screening mammograms in their eighties, similar to the NHS BSP in the UK, where patients can self refer. With the rising elderly population, and better breast-awareness, it may well be that we do more mammography in the elderly and reduce morbidity than we do for now.