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Increased access to care may lead to overuse of mammograms
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Increased access to mammograms may cause more harm than good, at least in older women with comorbidities, according to study results published in Medical Care.
Alai Tan, MD, PhD, senior biostatistician at the Sealy Center on Aging at the University of Texas Medical Branch in Galveston, Texas, said older women with comorbidities and life expectancy of 7 years or less may be exposed to lower quality of life and financial health when screened for breast cancer.
Tan said if cancer is detected, treatment can cause other problems, and if the patient is likely to die of other causes in a short period of time, the patient may experience more harm than benefit.
Unlike prostate cancer, there is no upper age limit recommendation for screening, according to Tan. “The American Cancer Society guidelines on screening, for example, have had no upper age limit,” she and colleagues wrote. “This is different from the case with prostate-specific antigen screening, where both the American Cancer Society and the American Urological Association have longstanding guidelines that exclude men with a less than 10-year life expectancy.”
For years, physicians and patients have become more likely to prescribe and accept mammograms as part of routine primary care, and access to mammograms has become more affordable through health plans. Tan said many physicians prescribe mammograms because patients have come to expect them. “Physicians are aware of the potential for harm, but we do find over-screening,” Tan told HemOnc Today.
The research showed that in 2008 and 2009, women aged at least 66 years with an average life expectancy of up to 7 years received mammography screening 28.5% of the time, and a much higher rate of 34.6% for women with a primary care physician. Substantial geographic variation was shown from 39.5% in areas with hospital referral regions vs. 19.5% in the bottom decile.
“If the screening is positive, the guidelines are to treat,” Tan said, adding that treatment may cause undue stress, financial burden and additional health problems.
However, the sensitive conversation with each patient who presents comorbidities and short life expectancy must be individualized, according to Tan.
“What is the potential benefit? What is the probability of harm of screening? Have that conversation and let the patient make the decision,” she said.
Disclosure: The researchers report no relevant financial disclosures.
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