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Does Mammogram ‘Decision Aid’ Help Elderly?

March 18, 2014
Written by: , Filed in: Breast Imaging, Practice Management
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An 11-page mammography “decision aid” for women over 75 significantly increased the number of conversations with doctors and may have discouraged some of the women from undergoing screening mammography.

The pamphlet, written at a sixth-grade reading level, certainly wasn’t designed to encourage mammography. It estimates that of every 1,000 women over 75, three who get mammograms will die of breast cancer and only four who don’t get mammograms will die of the disease. (The U.S. Preventive Services Task Force says “evidence is insufficient” about whether screening mammograms benefit women 75 or older.)

The pamphlet includes charts showing that heart disease, other cancers, stroke, and dementia are greater threats than breast cancer to women in that age group.

In a small (45 participants) pilot study of women age 75 to 89, 93 percent said the pamphlet was helpful. Among the participants, 53 percent talked to their primary care physician about the risks and benefits of screening within six months after getting the pamphlet—compared with just 11 percent who had had such a discussion in the previous five years.

Did it reduce the number of screening mammograms among women in that age group? Maybe. Among the participants, 84 percent had been screened within two years before participating. Only 60 percent of the participants underwent a screening after receiving the pamphlet—but the study encompassed a follow-up period of 15 months, not two years.

An article about the study was published in the March issue of JAMA Internal Medicine.

Mara A. Schonberg, MD, lead author of the article, said some women may not realize they have a choice:

Radiologists send you an annual reminder card. You’re just told, ‘Go.’

Dr. Shonberg was quoted in a New York Times online article last week. She is an internist at Beth Israel Deaconess Medical Center in Boston.

The decision about whether to get a screening mammogram involves more than statistics, Dr. Shonberg said: “Women go for reassurance, for affirmation of their health.”

Paula Span, author of the Times article, clearly is not a fan of annual mammograms for elderly women. She does concede, “Women who see the whole picture and decide to continue with mammograms—Medicare pays for one each year—at least have reached an informed decision.”

Related CME seminar (up to 15 AMA PRA Category 1 credits™): New Horizons in Breast Imaging

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