January 1, 2014

NOT UNIQUE:

Decision aids reduce mammograms among older women (KATHRYN DOYLE, Dec 30, 2013, Reuters)

"Approximately, 20 percent of U.S. women 75 and older have less than five year life expectancy and these women should not be screened since they are very unlikely to benefit and can really only be harmed," she said. [...]

"In practice, it may be faster for a physician to simply recommend a mammogram than to discuss patients' preferences around screening," she said. Doctors should be compensated for spending time discussing this issue with patient, she said.

"In addition, most of the educational materials regarding mammography screening have been uniformly positive. It takes a change in culture to acknowledge that there are both benefits and risks to screening and that each woman should be allowed to make an informed decision for herself."

All women should be informed of the risks and benefits of screening, she said, but especially those over 75, since there are more risks and uncertain benefits for this group.

The study did not follow the women to determine which, if any, were later diagnosed with breast cancer.

"Most women over age 75 should not get mammograms," Dr. H. Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy & Clinical Practice in Hanover, New Hampshire, said. "But this is not unique to mammography, or women," he said.

Welch authored another study on the risks of mammography screening for older women in the same issue of JAMA Internal Medicine. In it, he estimates that for 1,000 women who get annual mammograms starting at age 50 for 10 years, "0.3 to 3.2 will avoid a breast cancer death, 490 to 670 will have at least 1 false alarm, and 3 to 14 will be overdiagnosed and treated needlessly."

"As people get older - closer to death - there is less reason to look for cancer early," he said. "Most people, men and women, over age 75 should not be screened for cancer," Welch told Reuters Health in an email.
Posted by at January 1, 2014 8:37 AM
  
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