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| |  Cognitively Impaired Elderly Women Receiving Unneeded Screening Mammography SAN FRANCISCO -- January 14, 2010 -- A significant percentage of women aged 70 years or older in the United States who were severely cognitively impaired received screening mammography that was unlikely to benefit them, according to a study of 2,131 elderly women Overall, 18% of severely cognitively impaired women in the study received screening mammography, compared with 45% of women with normal cognitive status. “Even a screening rate of 18% may be considered too high,” said lead author Kala Mehta, University of California at San Francisco (UCSF), San Francisco, California. In order to benefit from screening mammography, she explained, “a woman must have a life expectancy of at least 4 to 5 years,’“ whereas the severely cognitively impaired women in the study had a life expectancy of 3.3 years on average. The potential harms are likely to outweigh the benefits.” Those harms, according to Mehta, include invasive follow-up tests such as biopsies in women who may not even understand why they are getting the tests; complications from those tests; surgery for asymptomatic growths that would never have caused problems in the woman’s lifetime; and diverting time and focus away from medical care that enhances day-to-day quality of life for persons with dementia. The women in the study were part of the 2002 wave of the Health and Retirement Study, an ongoing national prospective study sponsored by the National Institute on Aging that is examining the relationship between health, income, and wealth over time. Screening mammography rates were based on Medicare claims. Based on their study, which appears in the January 14, 2010 issue of the American Journal of Public Health, the authors estimate that approximately 120,000 screening mammograms were performed on severely cognitively impaired women in the United States in 2002. The study authors call for screening mammography guidelines that explicitly recommend against screening severely cognitively impaired older women. “I don’t think most people would say that putting a very demented older woman through screening mammography is a good thing,” said principal investigator Louise C. Walter, MD, UCSF. “Screening an active, healthy, independent 75-year-old woman who is likely to live for another 15 or 20 years is one thing, but severely cognitively impaired older women with limited life expectancies have immediate health challenges that must take priority.” Mehta emphasises that she and Walter do not advocate a strict cut-off age for screening. “Health status and life expectancy vary a lot among older people, so screening guidelines for older people should take into account health conditions that increase the risk for harm from screening, instead of focusing solely on age,” said Dr. Walter. “For each older woman, screening mammography should be an individual decision based on informed discussion with her physician. Our data can help physicians and caregivers make sure that elderly cognitively impaired women are getting the best care possible.” SOURCE: University of California - San Francisco
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