Overuse of mammography in elderly women with cognitive impairment
February 3rd, 2010 by 
David E. Williams of the Health business blog
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.
Posted in Policy and politics, Research | 
7 Comments »
February 4th, 2010 at 10:11 pm
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.
February 9th, 2010 at 2:17 pm
[...] oncologist friend spotted my blog post (Overuse of mammography in elderly women with cognitive impairment) and noticed that I’d been unable to access the full American Journal of Public Health [...]
February 9th, 2010 at 3:19 pm
[...] oncologist friend spotted my blog post (Overuse of mammography in elderly women with cognitive impairment) and noticed that I’d been unable to access the full American Journal of Public Health [...]
February 11th, 2010 at 11:49 pm
[...] Williams has written an excellent article about the overuse of mammography screening in older women with cognitive impairment. When you [...]
March 1st, 2010 at 4:20 pm
[...] the fact is screening can lead to plenty of harm as well as good. I followed up on that piece with Overuse of mammography in elderly women with cognitive impairment, which gets specific in detailing the actual harms to a sub-group of women that should not be [...]
May 14th, 2013 at 12:11 am
[...] written before about people with low life expectancies receiving unneeded screening and treatments (The overuse of mammography in elderly women with cognitive impairment) — but it’s [...]
May 14th, 2013 at 12:53 am
[...] written before about people with low life expectancies receiving unneeded screening and treatments (The overuse of mammography in elderly women with cognitive impairment) — but it’s [...]