Overuse of mammography in elderly women with cognitive impairment

Much has been made of recent guidelines recommending against routine mammography screening for women in their 40s. I tend to be more cautious than most in my approach to screening exams –more isn’t always better, especially when false positives set off a cascade of stressful, unpleasant follow-up testing and treatment. That’s even without considering the financial cost, which I think should be taken into account.

A new study (Impact of Cognitive Impairment on Screening Mammography Use in Older US Women) documents an example of overuse of mammography screening in women over 70 with advanced cognitive impairment. Eighteen percent were still receiving mammography screening even though their life expectancy was  just three years. One subgroup: those who were married and had a net worth over $100,000– had a screening rate near 50 percent.

The article is available to subscribers of the American Journal of Public Health. Since I didn’t pay the $15 for a PDF I’m just going by the abstract and an article on AuntMinnie.

The results are disturbing. According to American Cancer Society guidelines, women with life expectancy below 4 or 5 years should not be receiving mammography screening. AuntMinnie interviewed the lead author, Dr. Karl Mehta of UCSF, and asked him to speculate on why these women are being screened:

“It could be due to the preferences of the women and their families, or to their doctors’ preferences,” Mehta said.

But it’s possible, according to the researcher, that some doctors are recommending screening because there are no specific guidelines addressing women with dementia.

“Our data support the need for those guidelines,” Mehta said. “We think they should be more explicit about when to stop screening cognitively impaired older women.”

If “doctors’ preferences” refers to a preference for higher rather than lower income then I agree with Mehta.

February 3, 2010

7 thoughts on “Overuse of mammography in elderly women with cognitive impairment”

  1. We had something like this with a relative – retired Federal employee with Medicare/BCBS. She landed in a GYN’s office because of a GYN symptom. The doctor, rattling off a list of things she thought I would think were appropriate to bring up at an exam mentions mammography.

    Having recently gone through my own drill with DCIS and looking at my relative, who had been picked up out of her wheel chair, laid on the table and was currently mumbling I declined mammography screening. It wasn’t that I desired a slow and painful death from cancer for her. The victim of a stroke she was already having a slow death.

    My exact thoughts were “god help us if it would turn up DCIS (a serious but not life-threatening result of mammography) and we’d have to decline treatment or drag her to many appointments to take care of it.”

    I honestly believe that people accept mammography for infirm ed relatives because they have been trained to think that catching cancer early is always the right thing to do.

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