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| |  Screening Mammograms May Have Limited Benefit For Elderly Women CHICAGO, IL -- December 7, 1999 -- Continuing mammography screening for women over the age of 69 results in a small gain in life expectancy, according to an article in the December 8 issue of The Journal of the American Medical Association (JAMA). The study notes that women's preferences for a small gain in life expectancy and the potential harms of screening mammography should play an important role when elderly women are deciding about screening.
Dr. Karla Kerlikowske, 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 the age of 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. In their study, the researchers developed a mathematical model to compare three screening strategies: -- Screening mammography every other year, from the ages of 65 to 69.
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. The researchers report that screening was moderately cost-effective for women with high BMD, and more costly in those with low BMD. "Compared with discontinuing mammography screening at age 69 years, measuring BMD at age 65 years in 10,000 women and continuing mammography to age 79 years only in women with BMD in the top three quartiles would prevent 9.4 deaths and add, on average, 2.1 days to life expectancy at an incremental cost of $66,773 per year of life saved," the authors write. The authors note that other studies have shown that "routine screening mammography is cost-effective for women aged 50 to 69 years since breast cancer is the leading cause of death in these women, even among a screened population." They point out, however, that "in contrast, among elderly women, cardiovascular disease is the leading cause of death, with more women dying of other causes after detection of breast cancer whether or not they undergo screening mammography." The authors suggest that given the small benefit and moderate cost of mammography screening for elderly women, one reason to consider discontinuing screening after the age of 69 is the potential harm associated with mammography. As an example, they point 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 write. They suggest that a women's own 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 write. (JAMA. 1999; 282:2156-2164) Related Link: The Journal of the American Medical Association (JAMA).
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