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 Most guidelines agree that when a woman has short life expectancy
because of old age or serious health conditions, screening
mammography is of little benefit and presents potential harms. But
older breast cancer survivors and their doctors have little guidance
to help decide when it’s time to stop the screening, researchers
write in Journal of Clinical Oncology.
“Older women are often a forgotten group” in research, said lead
author Dr. Rachel Freedman of the Dana-Farber Cancer Institute at
Harvard Medical School in Boston.
“We know very little about how often we should do mammography in
older survivors and when it is OK to stop doing mammograms without a
detriment in a women’s outcome,” she told Reuters Health by email.
“It is likely that many women do not benefit from indefinite
mammography as they age.”
About 70,000 American women over age 70 are diagnosed with breast
cancer each year in the U.S., according to the American Cancer
Society. The American Cancer Society currently recommends that women
without a history of breast cancer stop screening when their
estimated life expectancy is under 10 years. Other organizations
suggest older breast cancer survivors should stop if they have less
than five years to live.
Using data from the National Health Interview Study, Freedman and
colleagues identified 1,040 women over age 65 who reported a history
of breast cancer and details on their health and mammograms in the
prior 12 months.
Just over one third were age 80 or older and nearly nine out of 10
were white. The research team calculated each woman’s life
expectancy based on age and overall health and estimated that about
9 percent had less than five years to live, and 35 percent had less
than 10 years to live.
Overall, 79 percent of women had had a mammogram in the last year,
and screening tended to decrease with life expectancy. But about 57
percent of women with less than five years to live had a mammogram,
as did 66 percent of women who probably had less than 10 years to
live. At the same time, 14 percent with more than 10 years to live
didn’t receive a mammogram.
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“We were surprised at the proportion of women with less than five
years who reported having annual mammograms, as well as the 14
percent with excellent life expectancy who didn’t,” Freedman said.
“This highlights the fact that we need to do better at tailoring who
is getting (and not getting) this testing.”
In recent years, health care providers and policy experts have
talked more about eliminating unnecessary cancer screenings among
patients who are too old or sick to benefit, said Dr. Richard
Hoffman of the University of Iowa in Iowa City, who wasn’t involved
in the study. Ongoing testing can lead to false positives,
overdiagnosis, overtreatment and procedure complications with little
benefit in return.
“Undergoing tests looking for cancer can be very stressful,
particularly for women who already have been diagnosed,” he told
Reuters Health by email. “We don’t want to needlessly increase
anxiety.”
At the same time, the lower number of women getting mammograms who
have longer to live should be addressed as well, Hoffman added.
Doctors need to be aware of a patient’s overall health, he said, and
“not deny an older patient appropriate preventive services just
because they are older.”
More research is needed on the effect of screenings later in life,
the study authors conclude. Also needed, they say, is a better
decision-making process for patients to decide which screenings best
fit them later in life.
“Making decisions about surveillance testing is challenging, as
evidenced by the conflicting recommendations from professional
organizations,” Hoffman said. “Ideally, doctors should be engaging
patients and making decisions together.”
SOURCE: http://bit.ly/2voOg1E Journal of Clinical Oncology, online
July 27, 2017
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