Close X
Monday, November 25, 2024
ADVT 
Health

HEALTHBEAT: Complex Issue Of When To Stop Mammograms

The Canadian Press, 18 Jan, 2016 11:30 AM
    WASHINGTON — Lost in the arguing over whether women should begin mammograms at age 40 or 50 or somewhere in between is the issue they'll all eventually face: when to stop.
     
    "There's a point at which everybody begins to scratch their head and say how much longer do you have to keep doing this?" said American Cancer Society specialist Robert Smith.
     
    It's an increasingly complex balancing act as older women are living even longer. The risk of breast cancer rises with age. But so do the odds of other serious illnesses that may be more likely to kill in a senior's remaining life span — or to make them less able to withstand the rigours of cancer treatment.
     
    "If we pick up a cancer in someone who's 75 and they die at 76 of something else, did it really matter? That's really the question here," said Dr. Susan Boolbol, breast surgery chief at Mount Sinai Beth Israel Medical Center in New York.
     
    Medical guidelines don't agree.
     
    The cancer society's advice: Women should continue mammograms as long as their overall health is good and they have a life expectancy of at least 10 more years. Last week, guidelines issued by the U.S. Preventive Services Task Force said there's not enough evidence to recommend for or against mammograms at age 75 and older, because that age group just hasn't been studied enough to tell.
     
    Getting such evidence is "critical, given the greying of America," said Dr. Jeanne Mandelblatt, an expert on cancer and aging at Georgetown University.
     
    Indeed, some in the 80-and-beyond crowd are as spry as 60-somethings.
     
    "People are taking better care of themselves," said Yale University pathologist Dr. Fattaneh Tavassoli. "If we don't start discussing it, it's going to be more difficult to come up with management approaches for these patients."
     
    She recently reported that Yale's medical centre is diagnosing more breast cancer at 90 and older, averaging about eight diagnoses a year since 2000, compared with one a year during the 1990s. Many were diagnosed after the woman or doctor detected an abnormality, not from routine mammograms, Tavassoli said. But she's asked if other hospitals see a similar trend and also wants to study what treatment they underwent.
     
     
    Marion Jones was 84 and active when a mammogram spotted breast cancer. Surgeons removed a small tumour but during follow-up chemotherapy Jones developed pneumonia and blood clots. She needed a portable oxygen tank for a year until her lungs healed.
     
    For Jones, mammograms were "just a habit" that she didn't question when a new doctor said she was due, and she's grateful her cancer was detected. But now 86 and healthy again, the Silver Spring, Maryland, woman recently told her oncologist that if her cancer ever returns, she doesn't want chemo.
     
    "She said, 'Marion, at your age you probably won't die of breast cancer anyway. It'll be something else,' " Jones recalled. "That's nice to hear."
     
    About 26 per cent of breast cancer deaths each year are attributed to a diagnosis after age 74, according to the American Cancer Society.
     
    "The question we have not really studied very carefully is what fraction of those deaths is truly avoidable," Smith said.
     
    Mammography does decline as women get older. About three-quarters of women age 50 to 74 have had a mammogram within two years, compared with 41 per cent of the 85-plus group, according to 2013 government figures.
     
    Mammograms bring pros and cons for the oldest women like they do for middle-aged ones, the possibility of reducing breast cancer death versus false alarms, unneeded biopsies and detection of a tumour so small or slow-growing that it never would have posed a threat.
     
    Georgetown's Mandelblatt used math models to analyze that balance, and estimated that healthy older women could benefit from regular screening through age 78 or 80. But among women who already had other moderate to severe illnesses, the harms of screening could outweigh benefits as early as 68, she said.
     
    If cancer is found in the frail, Mount Sinai's Boolbol notes there are less aggressive options that aim to stop a tumour's growth rather than eradicate it.
     
    She wants doctors and patients to have frank discussions about the woman's overall health in deciding how long to continue mammograms.
     
    "It really needs to be based on their health status, and not your age," Boolbol said. "Because it's not one-size-fits-all."

    MORE Health ARTICLES

    Humble Turmeric Can Help Treat Oral Cancers

    Humble Turmeric Can Help Treat Oral Cancers
    Turmeric, the familiar yellow spice common in Indian cooking, may also help treat oral cancers caused by a virus, says a study co-authored by an Indian-origin researcher.

    Humble Turmeric Can Help Treat Oral Cancers

    Cigar Smoking Not A Safe Alternative

    Cigar Smoking Not A Safe Alternative
    If you thought smoking cigars is less harmful than smoking cigarettes, you are wrong. New research associates many of the same fatal conditions as cigarette smoking.

    Cigar Smoking Not A Safe Alternative

    Why Do Dry Eye Cases Peak In April?

    Why Do Dry Eye Cases Peak In April?
    Dry eye -- the culprit behind red, watery, gritty-feeling eyes -- strikes most often in spring due to a surge in airborne allergens, a study says.

    Why Do Dry Eye Cases Peak In April?

    South-Asian Women In Canada At Risk Of Later Stages Of Breast Cancer

    South-Asian Women In Canada At Risk Of Later Stages Of Breast Cancer
    "Research has long suggested minority groups are among the least likely to be screened for breast cancer, impacting their survival rates and outcomes," said Ophira Ginsburg, scientist at Women's College Research Institute in Canada.

    South-Asian Women In Canada At Risk Of Later Stages Of Breast Cancer

    Fasting At Night Reduces Breast Cancer Risk

    Fasting At Night Reduces Breast Cancer Risk
    A decrease in the amount of time spent eating and an increase in overnight fasting reduces glucose levels and consequently may reduce the risk of breast cancer.

    Fasting At Night Reduces Breast Cancer Risk

    Experts Warn Pets Can Cause Illnesses, Especially In Immunocompromised Owners

    Experts Warn Pets Can Cause Illnesses, Especially In Immunocompromised Owners
    TORONTO — Pets are a wellspring of love and joy for their owners. But they can also be a source of disease and should be chosen with care if someone in a household has health problems, some experts suggest.

    Experts Warn Pets Can Cause Illnesses, Especially In Immunocompromised Owners