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Mammograms For The Terminally Ill? Really?

July 14, 2011
Written by: , Filed in: Breast Imaging, Medical Ethics
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Experts argue over whether and how often women should have mammograms. But everybody would agree that there’s no point in recommending screening mammograms for terminally ill patients, right?

Um, not right.

A new study, published online last month in the journal Cancer, found that nearly half of U.S. primary-care physicians surveyed would recommend screening mammograms for a hypothetical patient with inoperable lung cancer.

The average life expectancy for such a patient would be about 10 months. If she were to develop breast cancer, she probably wouldn’t be eligible for treatment anyway, according to lead researcher Corinne R. Leach, PhD, of the American Cancer Society in Atlanta. In an interview with Reuters, Dr. Leach said:

We found it very surprising and concerning that so many doctors would recommend screening. If a woman is not eligible for treatment, it doesn’t make sense to screen.

And yet, almost 48 percent of the physicians (surveyed in 2006 and 2007) said they would recommend a screening mammogram to a woman 50, 65, or 80 years old with terminal lung cancer—”indicating over-recommendation,” as the article abstract drily puts it.

Why would doctors so recommend? The survey didn’t address that question. Dr. Leach speculated that uncertainty over mammography screening guidelines might be involved.

Maybe. Maybe the respondents just weren’t giving a lot of in-depth thought to a few questions about imaginary scenarios in the middle of a longer survey. Maybe when faced with a real person in that situation, their responses might be different.

The national survey presented the doctors with several hypothetical patients and asked whether the respondents would recommend mammography screening for each. The theoretical patients were 50, 65, or 80 years old, and in good health, diagnosed with heart disease, or in the advanced stages of lung cancer.

The percentages of “yes” answers decreased with the age of the patients and varied by specialty. For example, among internists, 32 percent said they would recommend mammography to a 50-year-old woman with terminal lung cancer, while 11 percent said they would do so to an 80-year-old. Among obstetrician/gynecologists, 65 percent said they would recommend mammography to a 50-year-old with lung cancer, and 37 percent to an 80-year-old.

Dr. Leach said further studies were needed to determine how often in real life primary-care doctors recommended screening mammography to actual terminally ill women.

We concur. And we would also like to know this: if they did do so, why?

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