Women over 70 undergo mammograms despite warnings

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Seventy-year-old women choose to follow through with their annual mammogram after reviewing mammography pros and cons for women of their age, according to study results in the Oct. 22 issue of the Archives of Internal Medicine.

Although better informed than a control group and able to make an informed choice, 95 percent of the female participants remained positive about undergoing a screening, reported Alexandra Barratt, PhD, University of Sydney, Australia, and colleagues.

The researchers did report that just as many women in the control group, who received only standard information, also chose to continue screening.

Screening is recommended for women ages 50 to 69, but recommendations are more ambiguous for women 70 years or older, in whom the harm could outweigh benefit.

Yet, concerns remain about detecting and treating cancers in older women, which, without screening, would not affect patients' health or life expectancy.

The researchers assessed 734 women in a randomized controlled trial in New South Wales, Australia, conducted from August 2005 to June 2006. Women age 70 who had regularly participated in mammography screening were eligible for the trial. Women in the intervention group (367) received the decision aid, or booklet, while those in the control group (367) received standard information in the screening program.

The booklet with information, charts and worksheets provided details of the risks, benefits, options and the chances of the possible outcomes for each choice.

According to one of the scenarios in the booklet, screening 1,000 women 70 or older over the next 10 years could result in:

  • Two fewer women dying of breast cancer as a result of screening;
  • 15 more women diagnosed with breast cancer, and some would never have been found without screening;
  • 135 women have more tests after an abnormal mammogram, which may cause them to worry, although they do not have breast cancer; and
  • 824 women being correctly reassured that they do not have breast cancer.

After reading the booklet, the mean increase in knowledge out of a score of 10, was 2.62 for the intervention group versus 0.68 for the control group. Also, 73.5 percent made what they called an informed choice.

The researchers also reported that of the women randomized to the decision aid, 94.7 percent remained positive about continuing screening, and 95.9 percent of the control group were positive about screening.

One month after the intervention, no percentage difference existed between the two groups, who had participated in the screenings.

Louise Walter, MD, of the VA Medical Center and the University of California at San Francisco, and Carmen Lewis, MD, of the University of North Carolina at Durham, N.C., questioned whether these women are making informed decisions despite the potential screening harm in an accompanying editorial, "Is this high enthusiasm for screening among women in this age group appropriate?"