Elderly women have little need of mammogram

The advice that all women -- regardless of age -- need mammograms has pumped millions of dollars into the medical industry. However, recent studies have once again confirmed that older woman derive little benefit from the costly examination.

Continuing mammography screening for women over the age of 69 has no major benefits, according to an article in the December 8, 1999 issue of the Journal of the American Medical Association (JAMA).

The study noted that, although the mammogram may offer a small gain in life expectancy to some patients, the potential harms of screening mammography often more than offset that gain.

Karla Kerlikowske, M.D., of the University of California at San Francisco, and colleagues analyzed the value of continuing mammography for elderly women, looking at breast cancer deaths averted, life expectancy, and incremental cost-effectiveness.

They focussed in particular on how the outcomes were affected by the women's bone mineral density (BMD), a marker of lifetime exposure to estrogen that has been shown to be a strong predictor of breast cancer risk.

The authors point out that many women over 65 undergo BMD measurements to assess the risk of fractures, and these measurements may be used to help make decisions about whether to continue mammography screening.

The study found screening mammography was minimally beneficial among women aged 69 and older because of their shortened life expectancy and the risk of death from other causes, such as cardiovascular disease.

Continuing mammogram testing after age 69 would prevent fewer than 10 deaths annually and add, on average, just 2.1 days to life expectancy at an incremental cost of $66,773 per year of life saved, the authors wrote.

They suggested that given the small benefit of mammography screening for elderly women, one reason to consider discontinuing screening after age 69 is the potential harm associated with mammography.

As an example, they pointed out that increased use of mammography has led to a rise in detection of ductal carcinoma in situ (DCIS), a breast lesion contained within the milk ducts. While the risk of death from DCIS progressing to invasive breast cancer is very low, many of these cases are surgically treated with mastectomy or lumpectomy.

"Thus, early detection will likely increase the rate of surgical treatment of clinically insignificant lesions with little hope of impacting overall mortality given elderly women's short life expectancy and high risk of death from cardiovascular disease," they wrote.

The authors suggested that a woman's preferences for a small gain in life expectancy and the potential harms of screening should play a role in deciding whether to continue undergoing mammography after age 69.

"Elderly women who are bothered by medical tests, visits to physicians, and the discomfort of undergoing mammography, or who experience significant anxiety waiting for test results, and who are willing to accept a very small incremental risk of death from breast cancer, may rationally decline screening," they concluded.