Should age be a barrier to mammography?

Should elderly women undergo mammograms?

Like many of the issues involved in the mammography debate, this one has accounted for a wide variety of opinions. The United States Preventive Services Task Force (USPSTF), for example, recommends against screening for women 75 and older. Conversely, the American Cancer Society recommends that women continue to have mammograms annually as long as they are in good health.

Last year, a study presented at the American Association for Cancer Research found that women over the age of 75 who skipped annual mammograms were at an increased risk of dying from breast cancer, suggesting a need for continued screening in this age group. But, an article published earlier this year in the Journal of the American Medical Association by researchers from the University of California, San Francisco and Harvard Medical schools questioned whether the benefits of routine mammography for women over the age of 75 outweigh the risks.

According to Judith A. Malmgren, M.D, affiliate assistant professor at the University of Washington's School of Public Health and Community Medicine in Seattle, the problem with determining the effectiveness in this age group is the paucity of available research; elderly women don't make good candidates for clinical trials.

To that end, Malmgren, along with Henry Kaplan, M.D., of the Swedish Cancer Institute, conducted a prospective cohort study of 14,000 breast cancer cases, 1,600 of which were women over age 75. Their study--published last week in Radiology--found that the five-year disease-specific survival invasive cancer survival rate was 97 percent for mammography-detected cancers, compared to just 87 percent for patient- or physician-detected invasive cancers.

While these results are encouraging for those who advocate routine screening of elderly women, it still doesn't provide the kind of evidence necessary to sway the USPSTF. And some of the conclusions made by Malmgren and Kaplan have been questioned. For example, Gerrit-Jan Liefers, a surgical oncologist at Leiden University Medical Center in the Netherlands, wondered in an interview with HealthDay News if more women died from physician-detected cancers because they were more aggressive than mammography-detected tumors.

Ultimately, Malmgren suggests that age alone should be no reason to exclude the use of mammography. And considering that the lack of available research has led to some confusion about whether elderly women should undergo mammography, this study hopefully will spur efforts to fill in those research gaps, and also help physicians and their patients make more informed decisions about mammography's effectiveness in this population. - Mike (@FierceHealthIT)