When to stop screening? My 85 year old patient was
‘disappointed’ that I turned down her request for a mammogram requisition slip.
Her mammogram was a birthday ritual and had been for decades. She had no
unusual risk factors for breast cancer and performed breast-self examinations
monthly. While a matter of debate, finding breast cancer at age 85 may not help
my patient survive longer, but it may cause medical problems, diminish her
quality of life and cause unnecessary distress.
There is no doubt that screening mammograms will pick
cancers at an earlier stage. The question of what to do if a cancer is found
will be based on type of cancer, if there are other medical conditions,
expected life expectancy and the wishes of the patient. Most of the studies
that looked at women who had screening mammography after age 80 have found that
those women tended to be white, married, and have higher education and income
levels. They also were in better health with fewer other conditions such as
heart disease or diabetes. The data are not clear if early detection of breast
cancer in elderly women increase survival. For women with other medical
problems (lung disease, peripheral vascular disease, heart disease, diabetes,
rheumatologic disease), mammograms did not increase survival.
This discussion is about screening mammograms only. Any
breast mass or breast change requires an evaluation – which could include
mammogram, ultrasound or MRI.
I read an excellent guideline – women should have a yearly screening
mammogram until they believe that they don’t have ten good years left.
