Title

Screening Mammography Among Older Women: A Review of United States Guidelines and Potential Harms

UMMS Affiliation

Graduate School of Biomedical Sciences, Clinical and Population Health Research Program; Department of Quantitative Health Sciences

Publication Date

2019-06-01

Document Type

Article

Disciplines

Clinical Epidemiology | Diagnosis | Epidemiology | Geriatrics | Health Services Administration | Health Services Research | Neoplasms | Women's Health

Abstract

In the United States, older women (aged > /=65 years) continue to receive routine screening mammography surveillance, despite limited evidence supporting the benefits to this subpopulation. This article reviews screening mammography guidelines and the potential harms of such screening for older women in the United States. Published guidelines and recommendations on screening mammography for older women from professional medical societies and organizations in the United States were reviewed from the mid-20th century to present. Observational data were then synthesized to present the documented harms from screening mammography among older women. In 1976, the American Cancer Society recommended to screen all women aged > /=40 years with no upper age limit. With time, other major U.S. medical societies adopted their own screening guidelines without a consensus on age of screening cessation. A population-wide screening effort has largely continued without an upper age limit and with it, a growing body of literature on the harms of screening older women. Reported harms from screening mammography procedures have included physical pain, psychological distress, excessive use of health services from overdiagnoses/false positives, and undue financial expenses. These costs are particularly pronounced among special populations with limited life expectancies such as those of very advanced age > /=80 years, long-term nursing home residents, and the cognitively impaired. When potential harms, remaining life years, and the viability of available treatments are considered, the burdens of screening mammography often outweigh the benefits for older women. For some cases, an individualized approach to recommendations would be appropriate. National guidelines should be updated to provide clear guidance for screening women of advanced age, especially those in special populations with limited life expectancies.

Keywords

breast cancer, guidelines, mammography, nursing homes, older adults, screening

DOI of Published Version

10.1089/jwh.2018.6992

Source

J Womens Health (Larchmt). 2019 Jun;28(6):820-826. doi: 10.1089/jwh.2018.6992. Epub 2019 Jan 9. Link to article on publisher's site

Journal/Book/Conference Title

Journal of women's health (2002)

PubMed ID

30625008

Related Resources

Link to Article in PubMed

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