By Amy Engeler
On September 2 of last year, Tomomi Arikawa left her office door open as she slipped out to her two o'clock sonogram appointment. She expected to return shortly — the imaging center was just across town from her office at ABC News, where she was a story editor for 20/20. At her gynecologist's urging, Tomomi was going to have a tender lump in her right breast checked out. The lump felt squishy, like a piece of Bubble Wrap, not like a hard kernel or a marble or any of the objects tumors...
Achieving balance between the benefits and harms of screening is especially important for women with a life expectancy of 5 years or less. Such women might have end-stage renal disease, severe dementia, terminal cancer, or severe comorbid disease with functional dependencies in activities of daily living. Early cancer detection and prompt treatment are unlikely to reduce morbidity or mortality within a woman's 5 years of expected survival, but the negative consequences of screening will occur immediately. Abnormal screening may trigger additional testing, with the attendant anxiety. In particular, the detection of a low-risk malignancy would probably result in a recommendation for treatment, which could impair rather than improve quality of life, without improving survival. Despite these considerations, many women with poor life expectancy due to age or health status often undergo screening mammography. A sizable proportion of patients with advanced cancer continue to undergo cancer screening tests that do not have a meaningful likelihood of providing benefit. For example, among women with advanced cancer compared with controls, at least 1 screening mammogram was received by 8.9% (95% confidence interval [CI], 8.6%-9.1%) versus 22.0% (95% CI, 21.7%-22.5%).
Screening mammography in women older than 65 years often results in additional diagnostic testing in 85 per 1,000 women, with cancer diagnosed in 9 women. The testing is often accomplished over many months, which may cause anxiety. While screening mammography may yield cancer diagnoses in approximately 1% of elderly women, many of these cancers are low risk. A study of California Medicare beneficiaries aged 65 to 79 years demonstrated this clearly. The relative risk (RR) of detecting localized breast cancer was 3.3 (95% CI, 3.1-3.5) among screened women. Diagnosis of metastatic cancer was reduced among screened women (RR, 0.57), suggesting a benefit of mammography screening in elderly women, though it comes with an increased risk of overdiagnosis.
Screening women in their 80s and 90s should be performed on a case-by-case basis, with comorbid diseases and life expectancy taken into consideration when making this decision.