Doctors should focus on life expectancy when deciding whether to order mammograms for their oldest female patients, since the harms of screening likely outweigh the benefits unless women are expected to live at least another decade, according to a review of the scientific literature by experts at UCSF and Harvard medical schools.
National guidelines recommend that doctors make individualized screening decisions for women 75 and older. But the analysis, published online Tuesday in JAMA (March 31, 2014), concluded that since this age group was not included in mammography trials, there is no evidence that screening helps them live longer, healthier lives.
The authors said that many women in this age group receive regular mammograms anyway, with no discussion about the uncertain benefit or potential harms of continued testing, which include unnecessary treatment for slow-growing cancers or pre-cancerous lesions that pose no real threat to the women's lives.
They concluded that women who are expected to live a decade or more should talk with their doctors and weigh the potential benefits of diagnosing a dangerous but treatable cancer through mammography against the possibility of being misdiagnosed or treated aggressively for a cancer that posed no real harm.
"People should be informed that everything we do in medicine can have good and bad effects, and that goes for mammography," said Louise Walter, MD, UCSF professor of medicine and chief of the Division of Geriatrics.
The authors arrived at their conclusions after examining all the studies conducted from 1990 to 2014 that identified risk factors for late-life breast cancer in women 65 and older, as well as the studies that assessed the value of mammography for women 75 and older.
Since there were no randomized trials of the benefits of screening women over 74, they could not say whether mammography was beneficial for those women. Longitudinal studies
|Contact: Laura Kurtzman|
University of California - San Francisco