Mammograms After 65 Can Save Lives

But not every older woman will benefit from them, new research says

MONDAY, Nov. 17, 2003 (HealthDayNews) -- Is it cost-effective to continue to use mammograms to screen women for breast cancer after age 65? The answer appears to be a qualified yes, a new study reports.

An analysis in the Nov. 18 issue of the Annals of Internal Medicine finds, in general, the benefits of screening women over 65 for breast cancer every two years outweigh the costs and possible side effects, like false-positive results. That conclusion is drawn from a review of 10 previously published cost-effectiveness studies, the researchers say.

Based on current medical spending, it costs an additional "$34,000 to $88,000 per year-of-life saved" to perform those biennial tests, the study found.

"It's very comparable with other spending," says Dr. Jeanne Mandelblatt, a cancer outcomes researcher at Georgetown University's Lombardi Cancer Center and the lead author of the study.

Treating adults who have mild to moderate hypertension with a blood pressure-lowering medication, for example, costs roughly the same: $16,000 to $72,000 per year-of-life saved, the researchers note.

Many older women are being screened annually, "especially because Medicare covers that," says Cheryl Kidd, director of education at the Susan G. Komen Breast Cancer Foundation in Dallas.

The cost-benefit question looms, in part, because of a lack of data on the issue. Few older women were included in the original trials of mammography screening, according to the report.

Women are urged to have an annual mammogram beginning at age 40 to detect breast cancer before symptoms arise. Experts agree the years of life saved more than justify the cost of performing the tests.

But some women over 65 who suffer from other health problems, like diabetes, heart disease, hypertension or other cancers, may not realize the full benefit of early breast cancer detection. A woman might die of a heart attack, for instance, before breast cancer would kill her, Mandelblatt says.

The study authors also note that diagnosing breast cancer and treating it in someone dying of another disease can reduce her quality of life, especially if early detection and treatment fail to extend her life.

Individual health status also makes a difference. A vigorous 80-year-old may receive more benefit from mammography screening than a frail 70-year-old, Mandelblatt says.

Screening "becomes more costly and harms begin to outweigh benefits in the sickest women, such as those with dementia" or other conditions that limit life expectancy, the authors note.

The report's findings are consistent with guidelines established by the American Cancer Society. The society recommends women have a mammography every year beginning at age 40, citing no upper limit on age. It does say further research is needed on the risks and benefits for women with serious chronic health problems or short life expectancy.

For these women, especially, screening is "a personal choice," says Dr. Cheryl Perkins, the Komen Foundation's senior clinical advisor. "If she feels that screening would increase her quality of life and she feels it would increase her quality of health, then I think it's beneficial."

Mandelblatt says the new report is intended to guide future research and policymaking, not a woman's decision to get screened or not. Women still need to make those decisions in consultation with their health-care providers, she says.

While many Americans remain squeamish about rationing health care, studies like this one help to put a fine point on the costs, benefits and risks of investing in certain services and tests, the researchers say.

"If you have unlimited funds, it's not an issue," Mandelblatt says. "If you're in a third-world country, $100 per year-of-life saved may be more than you can afford."

More information

To learn more about mammography, visit the National Library of Medicine. For more on breast cancer, visit the National Cancer Institute.

SOURCES: Jeanne Mandelblatt, M.D., MPH, professor of medicine, Georgetown University Medical Center, and director, Cancer and Aging and Cancer Outcomes Research, Lombardi Cancer Center, Washington, D.C.; Cheryl Kidd, MPH, director of education, Susan G. Komen Breast Cancer Foundation; Cheryl Perkins, M.D., senior clinical advisor, Susan G. Komen Breast Cancer Foundation, Dallas; Nov. 18, 2003, Annals of Internal Medicine
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