Study: Cognitively impaired elderly women shouldn't be screened with mammo

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Cognitively impaired elderly women are found to often undergo mammography screening despite the lack of any probable benefit and guidelines should be established against screening this subgroup of women, said a study published in the Jan. 14 online edition of the American Journal of Public Health.

The study, which examined a cohort of the 2002 portion of the Health and Retirement Study--an ongoing national prospective study that examines the relationship between health, income and wealth over time--found that 18 percent of severely cognitively impaired women in the study received screening mammography. However, the “guidelines do not recommend screening mammography in women with limited life expectancies because the harms outweigh benefits,” said lead author Kala Mehta, DSc, geriatrics researcher at the University of California, San Francisco.

Mehta and colleagues noted that "screening" mammography is conducted to detect masses that are not causing any symptoms, but may grow to cause symptoms in the future, as opposed to screening conducted after a suspicious mass has been detected.

For the study, Mehta and colleagues selected 2,131 women age 70 and older. The authors noted that 45 percent of women with normal cognitive status were found to have undergone screening mammography compared to 18 percent of cognitively delayed women. This screening rate may  be too high, said Mehta, pointing out that screening can often lead to invasive follow-up tests such as biopsies, complications from those tests, surgery for asymptomatic growths that would never have caused problems in the woman's lifetime and the diversion of time and focus away from medical care that enhances day-to-day quality of life for persons with dementia.

Moreover, severely cognitively impaired women who were married and had a net worth of more than $100,000 were found to have a screening rate of 47 percent, said the researchers.

“In order to benefit from screening mammography, said Mehta, "a woman must have a life expectancy of at least four to five years, whereas the severely cognitively impaired women in this study had a life expectancy of 3.3 years on average.”

Based on their study, the researchers estimated that in 2002, 120,000 screening mammograms were performed on severely cognitively impaired women in the U.S. While the authors have suggested more explicit guidelines be established against screening this subgroup of older women, they noted that health conditions which increase the risk for harm from screening should be considered more than age alone.

"For each older woman, screening mammography should be an individual decision based on informed discussion with her physician. Our data can help physicians and caregivers make sure that elderly cognitively impaired women are getting the best care possible,” concluded Mehta.