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Should 80-Year-Olds Get Mammograms?

December 13, 2011
Written by: , Filed in: Breast Imaging, Medical Ethics
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A new study finds that half of women age 80 or older receive screening mammograms for cancer at least every two years.

Should they?

The study, published Monday in the Archives of Internal Medicine, examines rates of screening for breast, colorectal, cervical, and prostate cancer among the elderly in light of what the study calls “ambiguity of recommendations” regarding whether such screening is appropriate in that age group.

The U.S. Preventive Services Task Force, as part of the famous/infamous mammography guidelines it released two years ago, said there wasn’t enough evidence to decide whether those older than 74 should be screened.

But the new study, using data from the Centers for Disease Control and Prevention’s annual National Health Information Survey, found that among adults age 75 through 79, 62 percent were still being screened for breast cancer, 57 percent for colorectal cancer, 53 percent for cervical cancer, and 56 percent for prostate cancer.

Among those 80 or older, 50 percent had received a mammogram in the previous two years, 47 percent had undergone recent colorectal cancer screening, 38 percent had had a Pap smear in the previous three years, and 42 percent had had a PSA screening in the previous year.

Should people those ages still be receiving such regular screenings? Or will they probably die of something else before any detected cancers are likely to become a real problem?

The study responds this way:

With heterogeneity in the health status of this older population, it is likely that continued screening for certain population segments is warranted, but making that determination is complex.

In other words, it depends on the individual—specifically, on his or her health. That’s more or less what Louise Walter, MD, a geriatrics researcher at the University of California, San Francisco, says in an accompanying commentary in the Archives.

“Given the tremendous heterogeneity of the elderly population,” she wrote, “we need to move beyond using age alone to define who is being overscreened.”

She suggests focusing on eliminating screening of those for whom it’s clearly not appropriate, such as the terminally ill with less than five years to live.

That’s an easy call. Other situations aren’t so clear-cut, especially because little research has been done (or, frankly, is likely to be done) on screening among the elderly. And older Americans are going to resist any recommendations that come across as implying “you’re old and useless; hurry up and die so you’re not in the way of us younger people.”

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