The Mammogram Question

A large-scale study published earlier this year in the British Medical Journal (BMJ) cast doubt on the usefulness of mammograms for breast cancer screening. PremierHealth spoke to Dr. Lorraine Nardi of our Internal Medicine division to help clarify the matter.

I believe the recent talk about changes in mammography guidelines over the last year has to be taken in the context of all the other research that’s been done in previous years: new, interesting research does not necessarily negate old research.

I prefer staying with the standard guideline based on research done over many years: women between the ages of 40 and 75 should have a yearly mammogram. There is enough data to show that early discovery of breast cancer really makes a difference for some women. The problem is, if you go strictly by mortality and morbidity statistics, it can be hard to prove that mammography saves enough lives to justify the cost.

Mammography is not a perfect test—it may not help every individual as much as we’d like—but it does do a lot; it’s worth it in that sense.

The Over-75 Question

For women over 75 the question is a bit more complicated. As women get older, the risk for breast cancer does not go away, but breast cancers develop more slowly and grow more slowly. The statistics behind the guidelines look at mortality and morbidity, and the statistics say there is a chance that breast cancer in a 75-year-old woman will not affect her life expectancy.

I don’t like that reasoning or playing the odds in that fashion. In our practice, we have active ladies who are going strong into their 90s and even one hundred-plus. I don’t like the idea of stopping mammograms in a vigorous 75-year-old, it would be like we were not paying attention.

I tell my patients they should come from a place of information; what they do with that information is up to them. If breast cancer is found, for example, in an 82-year-old woman, I’ll talk to her and her family. I’ll make sure they know that these cancers in the elderly move more slowly and are easier to treat than in younger women, that they have options. If the woman is frail, can’t abide the idea of surgery or chemotherapy and they’re going to leave it alone, that’s fine. Once the patient has all the relevant information, the choice is up to the patient. That’s my feeling.

NOTE: Dr. Nardi’s recommendation for annual mammography for women between the ages of 40 and 75 mirror those of The American Cancer society the national Cancer institute, the American College of radiology and the American Congress of Obstetricians and gynecologists.