Mammograms after 75? Women should know pros and cons

mammogramWomen 75 and older often decide against having a screening mammogram when they’re given detailed information about the benefits and risks of the procedure, according to a study in JAMA Internal Medicine.

Both the American Cancer Society and the American Geriatrics Society recommend not screening older women who are in poor health and have short life expectancies, and the U.S. Preventive Services Task Force has found little evidence in favor of screening women 75 and older. However, guidelines do advise informing older women of risks and benefits of mammography.

But few women in this age group get adequate information, according to the study’s authors. Benefits are often overestimated and risks understated, they wrote, resulting in older women making decisions that may not be medically appropriate for them.

The researchers decided to develop an easy-to-read decision aid for women 75 and older who are contemplating whether to have a mammogram. It included information about breast cancer risk factors, life expectancy, risks and benefits of having or skipping a mammogram, and treatments for breast cancer. It also offered a values exercise to help women clarify their feelings about testing.

About the study

The study involved 45 women ages 75 to 89 who had scheduled appointments with their doctor between July 2010 and April 2012.

The women completed a questionnaire about mammograms just before seeing their doctor. They then read the decision aid. The women completed another questionnaire after their appointment was over.

The doctors were given the opportunity to read the decision aid before the appointments, but they were not required to talk about mammography with their patients.

Researchers followed the women through medical records and physician notes for 15 months.

Among the study’s findings:

  • The women answered more questions correctly after reading the decision aid than before reading it.
  • 82 percent intended to have screening mammography before reading the decision aid and 56 percent still wanted screening after reading it. Before the study ended, 60 percent underwent screening.
  • 93 percent of the women said the decision aid was helpful and would recommend it to others.
  • 30 percent of the women said the decision aid caused them anxiety. Many said they feared their doctor would be disappointed if they didn’t get a mammogram.
  • 73 percent of the doctors said the decision aid would help their patients make more informed decisions, and 93 percent said it would be useful to patients.

Limitations of the study include its small size and use of a single medical center. The authors also noted that some doctors believed the decision aid emphasized risks of screening over benefits. The authors noted they planned to revamp the decision aid and test it in a larger clinical study.

The take-home message
Women 75 and older should ask their doctor for a thorough review of the risks and benefits of having a screening mammogram, and the discussion should include topics like life expectancy, treatments for breast cancer and the woman’s personal values.

 

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