Aging Out of the Mammogram

Mar 16, 2020 · 102 comments
Marina (Southern California)
After reading Overdiagnosed: Making People Sick in the Pursuit of Health, by Dr. H. Gilbert Welch, et al. I decided to be more proactive concerning tests. I'm in my early 70s and have refused any more bone density tests, colonoscopies, and mammograms.
somebody (somewhere)
Just because you aren't in a quality measure of your physician doesn't mean you shouldn't get a test. That is true whether you are younger than the group in the measure of older. You have to own your own care to some degree.
Jill F (Portland OR)
Or how about if Ann Schonberg had commented, I wish I'd never smoked! This article is frustrating. As women age they deserve the most thorough healthcare available. Imagine being told at age 75 that you have breast cancer and you can choose to do nothing because you're evaporating and eventually going to die anyway. I'm writing as a 69 year old recent survivor with no family history of breast cancer--which is the norm not the exception.
NextGeneration (Portland)
They found my breast cancer at age 73. They said the only way to make sure it doesn't return is the annual mammogram plus five years of Tamoxifen.
Paula Span (New Old Age columnist)
@NextGeneration Screening mammograms, as in this large study, are performed on women without a breast cancer history. And the USPSTF guidelines calling for biennial mammograms are, again, referring to screening -- looking for cancer in someone who has no symptoms or history. Once women have a breast cancer diagnosis, as you have, they are in a different category.
Delia Lunsford (Maine)
There is an increased in some families for later stage cancer. grandmother at 70, radical mastectomy, aunt at 80, mother at 90 (receptor okay) and just this past year my youngest cousin at 62 who has done chemo and radiation as well as some surgery. The risk is real and mandatory for yearlies with us. Also, my mother-in-law died from breast cancer in her late 80s after never having a mammogram.
D. C. Miller (Louisiana)
Well someone has to make the payments on all those mammogram machines. Studies show that doctors who own an MRI business send more patients to get MRIs then doctors who don't. I would recommend that the machines be independently owned and that the exchange of gifts or money between the owners and medical offices be made illegal. In cases where a family member owns a machine they not be allowed to accept patients from their relatives. All of this is not a problem in countries where the gov't owns the medical testing centers.
Sandy Walter (Sunrise, FL)
Why do we need additional controlled studies? Just analyze the incidence of disease in women by age and diagnosis who have been getting mammograms over their adult life and make some educated guesses as when the need seems to be not necessary. It seems to me that we have the data. Gather it, analyze and draw some statistical conclusions. Then the medical community can update their recommendations and women and docs can make their own decisions.
LT73 (USA)
Where do we draw the line? It isn't really about whether providing a person age 70+ with screening or even access to healthcare because doing so would deprive a younger worthier person of that care it is really about how many we are going to train as healthcare providers, whether they are going to be paid enough to land in the wealthiest 10% and live the lifestyle involving nightly entertainment, daily golf or other chosen exercise and a cruise or vacation resort every ten or twelve weeks while also ensuring all their healthcare investments are earning record profits isn't it? The only real valid argument I think is whether the patient is adequately informed of the impact treatment will have on their quality of life and whether foregoing it when other issues are likely to kill them first might give them the best remaining months or years. Otherwise this really is about death panels due to our unwillingness to take profits out of healthcare and fund it and plan ahead with facilities, equipment and staff to ensure everyone can get excellent care without the need to ration it.
Cathy P (Greenville, NC)
My mother had a mastectomy 25 years ago, and still gets an annual mammogram every year even though she is now 88, with COPD and other health issues. I asked her why did she still have an annual mammogram, and the only reason was because her doctor ordered it. When I asked her what she would do if they told her they found a tumor, she replied she would do nothing. So why do it? Same with a colonoscopy. Why have the procedures if you are going to do nothing about the diagnosis?
LM (Maryland)
@Cathy P I don't think any of us are always rational about things, especially around our mortality, but certainly she may have found comfort in doing it. I understand her conflict and can never know until you are diagnosed whether you truly would not treat it. I can see my 88 year old mother saying the very same thing.
grmadragon (NY)
I quit doing all of those predictive tests when I turned 70. I also got DNR tattooed on my chest. Now, I'm almost 80, still kickin'! My MD still tells me once a year that I should have all of those tests. No Way!
Honor senior (Cumberland, Md.)
Just one more reason that a "Death with dignity" pill should be available upon request to those of a certain age!
Patricia (San Diego)
This is more misunderstood statistics and ageism. If the population is big enough, you get “reversion to the mean,” i.e. true variation washes out when you create a statistical soup of 20-somethings thru 99-somethings. Per my OBGYB: Likelihood increases over time and caught early, intervention is more likely to be successful. He recommends getting an annual mammogram even if the insurer won’t cover it. He also personally calls with results. BTW: Longevity isn’t a disease, just evidence of a robust gene pool.
Linda Kazel (Ithaca, NY)
I was diagnosed with Stage 1 breast cancer at 70 after my annual mammogram. Personally, I don’t care what the health care community does or does not recommend for mammograms in older women. Mine saved my life. I will continue to have a mammogram annually. If my insurance refuses to pay for it, because we all know that insurance companies will use any excuse to deny paying for even some preventative diagnostic treatment to save money (e.g. Pap Tests), I’ll fork over the funds and pay cash for it.
Ellen (Colorado)
At 67, I received my reminder to get my yearly mammogram. I debated skipping it, but decided to go get it. An aggressive tumor was found, stage 3, even though I had had a clear mammogram the year before. A few days after the mammogram, the announcement came out that people my age could skip to every other year. I would have welcomed the chance to skip it- and I would be dead now. Just saying.
MLChadwick (Portland, Maine)
One reason offered for avoiding mammograms is to reduce one's worry (assuming a mammogram was positive). I'm in my 70s. After all these years, I'd feel more worried, not less, if I'd been persuaded not to find out whether or not a cancer was growing with me. I'd want to find one if it exists, get it cut out while it's tiny, and move on. Glad these are guidelines, not (yet) rules.
mm (usa)
Err on the side of caution. I’ve known too many women who have been diagnosed with late stage breast cancer because they never had a mammogram (why their physician never urged to do so was part of the problem, but more than ever we need to be advocates of our own health)
Gail A Rodrigues (Acushnet, MA)
My 91 year old mother was told following a mammogram in 2018 that going forward she no longer needed the procedure. However, that mammogram revealed a stage 1 breast cancer. She had a lumpectomy, no chemo or radiation due to her age, but took tamoxifen which later led to the development of a DVT in her leg. Now 93, she is off meds for the cancer and is receiving close monitoring by her oncologist and mammograms twice a year.
S. Cullinane (St. Louis MO)
I am a 79 year old female with no history of breast cancer in my family nor any other flags except dense breasts. At age 77 I was diagnosed with Stage 1 breast cancer, had a lumpectomy, chemotherapy and radiation treatments. I am now on an anti-estrogen for 5 years. I strongly recommend that older women continue mammograms and urge that they be 3D mammography, as it reveals what regular mammograms do not. My tumor did not show up on regular mammograms.
S Turner (NC)
I’m 60 and get called for a mammogram every year—although I’ve never had any problems. I kinda fudge it and go in about every 18 months. This is the first time I’m seeing that it should be every TWO years. Same with Pap smears. Never had a problem, older, negative HPV test—and yet my doc, even though she’d said before that an annual exam was important but NOT a Pap—keeps trying to do a test every year. And insurance pays for it. This is why patients are confused and why our system is so expensive.
Drusilla Hawke (Kennesaw, Georgia)
This is perhaps the most breathtakingly misguided article I’ve read all day. At 75, my cousin was diagnosed with stage-one breast cancer. Her annual mammogram saved her life.
MSC (Virginia)
There are two things missing in this article. One is the tendency of the medical profession to downplay women's health issues. A mammogram is one test that gives women a sense of control over their own health. For many older women, being told not to get the test is a form of 'mansplaining.' The second is the black hole in our healthcare system that does not allow each older person a health counsellor to assist in deciding between competing medical issues and protocols from different, often disinterested, physicians. My mother's well-being was destroyed during her last two years by aggressive, and at times competing, treatments that were never going to work.
Liz (South Carolina)
I took my mother-in-law (age 94) to her GP for nausea, third time in a week. She had been feeling awful. He gave her even more Nexium, but made her stand waiting at the check-out desk until it had been determined that her annual mammogram was scheduled. By the end of the week, now in ER, she was having a heart attack. People still go to this doctor!
elise (nh)
What i want from the health care system (or what we laughingly call it in the USA) is the ability to self advocate and to make informed choices about my health care. Give me the inofmation, and let me decide. Provide me with health care professionals who know how to listen, who understand not just my physical helath but my mental health, desires for quality of life and end of life options, etc. Then, let the choice be mine. Especially as the data is at present lacking.
Brenda Snow (Tennessee)
I’m nearly 79. When I broke a hip at 75( fell down the stairs) the doctors considered whether or not I could benefit from replacement surgery! Yes, I could, and did and recovered very quickly because I knew to ask for an anterior approach surgery. I was very active and still am. I get mammograms because more women in my age range get breast cancer. If I am diagnosed, I will get treatment. As long as I can make my own decisions, I will get mammograms.
Nancy (California)
My mother, who is still living her life, had been having regular mammograms for years, especially after two DCIS discoveries and treatment. At age 83, she had a mammogram, which was “negative.” Two short months later, her doctor found a lump in her right breast (not sure how the mammogram missed this, it was quite easy to feel at the top of the skin of the breast, not buried deep in tissue). When I mentioned this to the surgeon, he just shrugged and said “things get missed”. This now puts me at higher risk, in my sixties. I have tried to obtain a follow-up ultrasound for myself but you would think I was asking for major surgery, can’t have one for pro-active reasons. My confidence in guidelines for women’s healthcare is considerably eroded. Nevertheless, my mother had a total mastectomy at 83 five years ago and continues on with her very productive life, and we are so grateful to have her.
Concerned Mother (New York Newyork)
I have two friends who developed breast cancer in their mid eighties. Both were vigorous, healthy, active women with family lives, social lives, and cultural lives. They both died of breast cancer, even with mammograms, but their lives, which they loved, were prolonged. A horrifying example of the idea that older women are extraneous.
The Dude (Spokane, WA)
My 71 year old wife had yearly mammograms with no issues until the last one in December 2019. Even though it had only been a year since the previous exam, the last one produced a diagnosis of aggressive triple negative inflammatory breast cancer involving three lymph nodes. We’re not sure what the future will bring for her, but we are convinced that, without the mammogram and it’s results, she would most certainly be in a much different situation this coming December.
PFS Jr. (Phila.,Pa.)
When I started my surgical training in 1965 the only option for a woman as a " Cure " was a radical mastectomy . No ifs and or buts. look how far we have come ! As this and other similar articles suggest , there are many options available to the informed woman. Sit down with your doctor , who knows you best , and discuss your situation. If no such is available , or he/she seems reluctant or poorly informed , seek a recommendation from a friend or family member. As the old TV clothing store ad said , " An informed customer is our best client."
Ginger (Delaware)
The advice of a Physician, the assumption that the screening is required weigh on patients, and their caregivers. Who wants to pass up a mammogram that might find cancer! My MILK, who was bedridden after a stroke, had some uterine bleeding that landed her in a doctor's office, and the doctor proceeded to run down the screening procedures she might want to bring up to date. This was a woman who arrived in a wheelchair and didn't know what was going on. We passed on it. I said to the doctor, "it might find something and then we'd have to do something about it." No blowback from the doctor about that. No one likes to say that their loved one is too old or too infirm. Probably they would set an age where the doctor isn't required to bring up the screenings, but if the patient has their marbles and requests it then it's OK.
Brenda Snow (Tennessee)
Or, perhaps we can treat older women who have all their marbles as the adults they are, mention it, and let them make informed decisions. Despite my gray hair, I am still the same person I always was, a fact that too many people don’t seem to realize.
Colleen M (Boston, MA)
@Ginger my Mother was no longer cognitively present as a result of a massive stroke. When I was speaking with my Father on the phone, he said that he had brought my Mother for a mammogram. I asked why? Even if something had been found, would he put her through the treatment regimen that he had watched me go through (surgery, chemo, radiation)? If the condition would not be treated, there is no reason to screen for it. Even if I am fully cognitively present in my 70's, I will carefully consider what tests I will subject myself to, and what drugs I will take to treat any chronic conditions that I have.
Mary Ann Donahue (NYS)
My godmother (now deceased from old age, not related to breast cancer) was still getting annual mammograms in her early 90's. I questioned why since she had no history of breast cancer. Instances such as this makes me skeptical whether money/insurance influences such recommendations more than it should.
Ken Krigstein (Binghamton, NY)
My late mother insisted on yearly mammograms despite some physician opposition. At age 80 her mammogram detected breast cancer, and she was treated appropriately. She died a few months ago at age 88 due to unrelated causes. You can draw your own conclusions, but in my family we’re thankful that she didn’t go along with the anti-mammogram trend.
Barbara (Chicago, IL)
@Ken Krigstein my grandmother had a similar experience in her early 80"s. She had a breast removed and lived into her 90's. Well worth the screening!
Ilene Traverso (Sonoma County, CA)
Similarly, my mother’s mammogram at 78 discovered Stage 3 invasive breast cancer. But a lumpectomy, one dose of chemo, weeks of radiation and meds, she lived happily and actively until 85. You can believe that I am a firm believer in mammograms. In fact, one discovered an aggressive form of cancer in me in my mid-60s.
Karen Karp (Hoboken)
At age 80 my mother stopped her regular screening. She was a healthy person and there was no history of breast cancer in our family. Out of no where her arm became swollen and developed a painful rash. This turned out stage 4 breast cancer which had spread to the lymph nodes beneath her skin. It’s was terribly painful. I wish my mom had had a mammogram .
puppylover (texas)
i am a retired life insurance actuary. the first thing you need is projections of a 70 year old women's life expectancy. let me tell you, it is going to shock the crap out you...maybe literally. the basic limit of mortality for females is about 113 at today's medical technology! my wife is 69. tomorrow is promised to no one but i am thinking 120 is possible. both our mother's are in their mid-90s. i recently broke it to them that they might live to age 100+. i did not tell them my real feelings...they may life well past that number.
memyownself (Upstate NY)
Even though there is some history of breast cancer in my family, I have never felt that it was danger to me. What I have felt was that mammograms were dangerous to me! They have usually been quite painful (I mean 8 on a scale 1-10) and left me with bruises for a week. I warn the technician that I have a double cyst in one breast and ... well, muscles there. Nonetheless, at my last mammogram that cyst was ruptured and I leaked fluid for two weeks, and the usual bruises. I am 78, and frankly, think these tests were a waste of time and led to unnecessary treatment for that cyst (which was not successful, either).
Zejee (Bronx)
You have never “felt” that breast cancer was a danger to you. I “felt” the same way until diagnosed with breast cancer
Susan Baltimore (California)
A close friend of mine who has generally enjoyed good health throughout her life has maintained her routine of a yearly mammogram. Last month she was told, at age seventy-eight, she has breast cancer. She is scheduled for a lumpectomy later this month.
SCL (Connecticut)
My mother was just diagnosed with a small but malignant tumor in her breast. She had skipped a couple of years on the mammogram until her new primary care doctor encouraged her to get one and likely saved her life, as it was caught early. Lumpectomy scheduled. Zero family history of breast cancer in our family. Be careful about putting this off, friends! Stay well.
Cindy (Vermont, USA)
Very sadly, the overarching lack of studies on ANY woman's health issues is sorely lacking. I'm a 61 year old woman, but most medical guidelines and practices are based on years and years of studies on white men. This misogynistic perspective kills many women when their symptoms are poo-pooed away by doctors trained in medical schools that still isolate the systems of our integrated body. We should do better than this, shouldn't we?
Moose’s mommy’s (ATlanta)
Couldn’t agree more. Infuriating. They probably tried to test the first birth control pills on men....
R. Anderson (South Carolina)
As we age we are more likely to develop cancer but although we know we are not immortal we hate to think we will die prematurely because of our own neglect or stupidity. And then there is the always looming financial benefit to the medical industry of testing and treatment.
Paul (Brooklyn)
Hey gang, remember you can abuse anything including motherhood, apple pie and yes our medical industry and all three have been abused. The trick is to find out what works and what doesn't. Countless pills, procedures, tests have helped and/or saved lives but it seems almost as many are useless, dangerous or money grabs. The NY Times is very objective re this issue, calling out what works and doesn't.
Gill (Toronto)
I was diagnosed with breast cancer at 61. I had chemotherapy, a mastectomy including auxilla resection and then 26 rounds of radiation. Followed up by 5 years of letrozole which is almost over. And that was going to be that. And then my sister also got breast cancer. So now I was eligible for genetic testing which is very costly but covered by our health care services. I have BRCA 2 as does my sister and my daughter. Ovaries removed. Now trying to decide whether to have a full mastectomy of the other breast or rely on 6 month mammograms plus a yearly MRI. Should I continue with letrozole although bone density is a concern. This is a discussion I am about to have with my oncologist. I am grateful to have options although the access to an MRI is apparently in question for woman over 70.
poslug (Cambridge)
Won't more genetic testing impact this analysis? How random was the selection of women studied to date and was there a follow on to analyze the women who did develop breast cancer for correlations?
I have my doubts (Germany)
My mammogram did not detect the two tiny lumps in my breast. The Pat Scan for a different issue did. At the appointment with the surgeon, she told me the biopsy showed I did not have breast cancer but NHL. I was happy because I had no clue what the NHL meant. The haematologist suggested radiation. I did not comprehend (I had cancer PTSD) that my cancer is an incurable very often slowly progressing cancer. The radiation I agreed to did harm to my oesophagus, it did not stop cancer to spread to my other breast and other parts of my body. Being 80+ I should have said no to the radiation. I am still alive 3 years after diagnosis but not because of unnecessary treatment.
Gretchen (Houston)
My mother was diagnosed with breast cancer in her 80s, so I'll keep on getting mammograms, thanks just the same.
Clare Durst (Topsham, ME)
Last August I was 84 and had a mammogram for the first time in several years - the yearly nudge had not happened. I discovered a lump so got sent by a PCP to have one. There were four tumors in one breast. It took a few months, but after 12 weeks of chemo and a mastectomy, I am cancer free (but of course looking at the covid-19 threat). It appears that in the last ten+ years there has been a large increase in the number of people over 80 who are having surgery such as this and surviving and doing well. There seems to be no research on people over 80. Research on people over 60 is not useful for the "old old" like myself who have no major health problems, though I know many in my own retirement community.
ultimateliberal (new orleans)
I was first diagnosed with breast cancer at age 76 and had immediate surgery of one breast and two lymph nodes. Six months later, at a follow-up, a lump concern in the other breast prompted an immediate mammogram and supplementary sonogram, which detected a benign mass. It's never too late for mammograms.....I have another scheduled for next month (on the remaining breast) one year after my last one. I am angry that my daughters whom I bore late in life are not permitted--according to their health plans-- to have mammograms until they are 40 yrs old.
Lincat (San Diego, CA)
These "guidelines" will just make it easier for insurance companies and Medicare to stop covering routine mammograms for older women. The effect will be that these women will no longer have them. I am 71. My doctor refuses to do Pap smears as a result of "guidelines". Hopefully, I will not be a victim of any illness for which early screening of older women is deemed unnecessary by medical protocol.
Elizabeth Barrett (San Francisco)
@Lincat I too was the victim of a gynecologist who refused to do a Pap when I was her patient for the first (and last) time. I was 58 and had always had an annual Pap. She waited until I was in the stirrups, at my most vulnerable with her internal examination taking place, to tell me that guidelines stated that I did not need a Pap. I have a remarkable female cancer history, as noted in my comment below, so I was beyond shocked and needless to say, very uncomfortable on all levels. Many anti-testing ‘recommendations’ are creeping to younger populations. I believe these are often driven by cost savings supported by health insurers. I also believe that insurers reward physicians financially based on their submissions to the insurers for payment for services rendered. It’s all negotiated. Let’s hope this potentially deadly business practice, which goes against supporting health of human beings, does not accelerate and become an epidemic in the US.
Jane Doe (NY)
Dr. Shonberg has two grandmothers with breast cancer? There was another article about her 98 year old grandmother re this on Sept. 14, 2018. I am so sorry.
Paula Span (New Old Age columnist)
@Jane Doe Very observant! Her other grandmother declined a biopsy, at age 98, so it's unclear whether the mass found was breast cancer or not. But note that neither of her long-lived grandmothers died of breast cancer. One died at 100, after a stroke. The other died of emphysema at 88.
Joan Rogers (Pittsburgh Pa.)
Each individual must decide for themselves what they feel most comfortable doing or not doing. Having said that, I believe each individual needs to have all the information to make their decisions. After a mastectomy and some years later a lumpectomy and annual mammograms I was told this January I could only have a screening mammogram which is recommended for women with no history of breast cancer. We have a broken system that is dangerous for people like me. How can we fix this?
Carmine (Michigan)
An aunt died of breast cancer, a very painful death that could have been prevented by a mammogram. She was in her 80s and in otherwise perfect mental and physical health when she was told she could not have any more mammograms, too old. Living in a rural area, there was no second option for her. She was from a family that regularly lives into the late nineties in good health, and many centarians, but that was not taken into account. I’m pretty sure all the doctor saw was the numerical age, not the person.
As someone who no longer has breasts due to cancer and is under 50, I would ask what could it hurt to get your mammogram at any age? I ask all my loved ones of all ages to get screened. I just took a 36-year old friend for a double mastectomy, she wasn’t even at the age for screening yet. Please get it done. How would you ever explain to your family that you are going to die because you didn’t feel you needed to go for a screening?
nurseJacki (Ct.usa)
Ok..... it is a personal decision after age 70. But... what about outliers? My dear aunt .... the one that helped our moms raise us and married at 40 and had no kids but us and our babies never was much for exercise and the nature life. Hiking and bugs no way. She baked and went to daily mass and prayed a lot on a rosary. We all loved auntie. She had a primary care doctor who sent her for a colonoscopy at 60 and told her she had precancerous polyps. He followed that w a trip for her to an orthopedic doc for chronic back pain. When the doc did a Cat Scan he saw pervasive tumors in Auntie’s breast. And cancer in her bones . By this time she was 80. She had not had a mammogram that particular year of bone cancer diagnosis. So researchers with theoretical hypothesis. Please stop telling women and men to discontinue or slow down regular testing for abnormal growths in our bodies. And find a new diagnostic test soon for ovarian and pancreatic cancers. Chemo is torture. Find a better alternative. Billionaires are you even listening??
cheryl (yorktown)
There's probably a bold line between appropriate and inappropriate use of mammograms and treatment for women ( or men) who are not only "old" but medically fragile, or likely to suffer more than gain from followup. The line starts to fade for others, depending on personal factors, which means that we do need to know the statistics - 'we' meaning both patients and doctors, and have a good evaluation of any cancerous growths that emerge. At about 69, I had some calcium deposits that showed on a mammo, a very typical finding; then a negative breast biopsy. Did the biopsy become part of those stats that would look like "unnecessary" followup? To me it was sensible, because my expected longevity is out in my 90's, god willing. After a 9 month and then a year check, I'm prepared to go to biannual checks. But I'm not stopping altogether. I think f a friend whose detection and treatment gave her about 5 years of good living, before the cancer struck again with vehemence ( and after evaluation, she opted out of further intervention. Much depends on your health at the time of the discovery. It seems possible that the more we learn, the more individualized the approach will become. It has been very important to put the brakes on automatic screening and treatment, which have often failed patients by putting them on a conveyer belt in a mechanical view of medicine. The key is informed decision making - and understanding the odds.
Jean (Connecticut)
One's family history matters. A large percentage of my many female relatives--aunts and even great-aunts--died in their mid-90s. But very few relatives have had cancer. This suggests that members of my generation need to balance longevity against cancer risk. Under the circumstances, with good health at 72, I continue to have mammograms.
Dr. J (CT)
My mother was treated for breast cancer in her late 30s (in the early 60s), and underwent a double simple mastectomies (at the time, radical, as radical mastectomies were standard). Then, in her late 70s, she discovered lumps, and had those removed — and it was breast cancer, but a different type, and she refused radiation treatment. She then lived to 93, and died of other causes. Obviously, she didn’t undergo screening mammography. And from what I’ve read, it isn’t clear that screening mammograms save many lives; rather, it’s improved treatment that does. And our paradigm that the earlier a cancer is detected and treated, the better the outcome, is undergoing revision; not all cancers are the same: some are sluggish, and would never cause a problem; others are so aggressive that by the time they are detected it’s too late for treatment to have much effect; and some small percentage may be affected by treatment (but note that treatments are not 100% effective, and probably not even close). But does this benefit outweigh the harms of screening mammography? The harm is due to treating those cancers which would not cause a problem (and for which treatment is too late), because the treatments themselves can cause harm. A lot of harm, up to and including death.
Kyle C (Washington DC)
@Dr. J Thank you for this. A lot of these comments so far are overlooking the facts that (1) mere discovery of a cancerous mass does not mean action is warranted and (2) we all die of something, to put it bluntly. Some people are writing as if an octogenarian would have lived to 102 had she not developed breast cancer. I’m 54 and I choose to just assume I have “prostate cancer,” the only questions being (1) whether someone will find it and (2) whether it will kill me before something else does.
Dr Sangeetha Kolluri (San Antonio, TX)
As a breast surgical oncologist, I am glad this topic is being reported on but the writer missed an incredible opportunity to present both sides. In my practice, it’s common to see an older patient (>75) with a neglected breast cancer. Most often, this occurs because the patient was told to stop screening after 75, and wasn’t practicing breast self awareness. So she presents at 79 with a large locally advanced breast cancer which is a large mass, local skin changes, /- metastatic spread to the lymph nodes in her armpit. If this lady had undergone breast cancer screening, this most likely would have been a simple lumpectomy (same day surgery). Often we can skip any lymph node sampling in this population. We almost never need to give chemo, and can often forgo radiation, and just take a daily pill (aromatase inhibitor). Instead, with her locally advanced breast cancer, she’s now mandated to a mastectomy, with an overnight stay at minimum, increased peri-operative morbidity due to her other medical conditions, painful drains to remove fluid after surgery, and much harder recovery. If her lymph nodes have cancer, we have to remove those lymph nodes (axillary lymph node dissection), which increases her risk of lymphedema. She will likely need post-mastectomy radiation, and may even need chemo. She may suffer loss of self-image due to the loss of her breast. Is there a difference in survival? Perhaps not. But the difference in morbidity is MASSIVE.
Dave (Michigan)
@Dr Sangeetha Kolluri Excellent point. Locally advanced breast cancer can lead to considerable pain, deformity, and expense that can be largely avoided by early intervention. Prostate cancer is different. Early treatment can lead to all manner of morbidity such as incontinence and sexual dysfunction in men who may well never require any therapy at all.
Carol (NM)
@Dr Sangeetha Kolluri Agree with one difference. I found 5 years of "Just a daily pill" to be the most excruciating part of my breast cancer treatment. I had 2 mastectomies with little pain, the drains were no trouble, 1 axillary node dissection well treated by physical therapy. Never had lymphedema. I chose a simple mastectomy after two years of living with one breast and not able to wear anything but sweatshirts. (I could not have reconstruction because of other cancers found at the same time needing to be treated with radiation and chemo. There was a time crunch. ) Anyway, that little pill started at age 68 sucked the estrogens out of my body and brain. After a few months I felt 80, after 3 years I felt 90. This all gradually goes away after 5 years of the pill. Every cell needs some form of estrogen, and they all scream in pain when they do not get enough. I reluctantly say the pill is worth it if you can manage life with it. Some really can't tolerate it so it should not be presented as "you must take this pill or else".
Di (California)
One in 1000 over ten years? Is that a typo?
Paula Span (New Old Age columnist)
@Di No.
Dori Sanders (Saratoga, CA)
@Di No, Di, it is a lot of BS, just like much of the medical advice given to the elderly. What many of the health advisers want to say is "why don't you just bite the bullet and die gracefully?"
Richard Plantagenet (Minnesota)
Consider whether an older woman has "dense" breasts, since a tumor on a mammogram of a dense breast will look like a white kitten in a blizzard. Half of all women over 40 have "dense" breasts, and would be wise to insist on other methods of imaging, such as MRI or ultrasound, as my mother - at 84 - has done.
Elizabeth Barrett (San Francisco)
@Richard Plantagenet Your mother is wise. My former gynecologist, from whom I ran after one visit, told me I would not need an MRI - despite my having dense breasts, a prior LCIS diagnosis and prior MRIs -as she was writing the presciption for my annual mammogram and sonogram.....thus, prior to having the receiving mammogram and sonogram results. I was 58. I had an upcoming appointment with a geneticist who, without prompting from me, wrote a prescription for a bilateral breast MRI. Some physicians view and care for patients as human beings; some view patients as numbers and are in bed with the insurance companies. Clearly, we all need to make our own healthcare decisions.
I am 73 and would be very happy to be in a study and give up the mamograms
Jane Doe (USA)
This is really upsetting. Women should be able to decide for themselves whether or not to age out of mammograms and or treatment for breast cancer in later life. And when we consider the financial context of health care and insurance, I find myself wondering about both the current profit-driven insurance industry as well as a Medicare for All (without the private option) that may very well end up rationing health care. As an individual, I may very well decide to stop certain screening measures at a certain age for some of the reasons outlined in this article. However, I want that decision to be mine.
Paula Span (New Old Age columnist)
@Jane Doe That decision is indeed yours, Ms. Doe., and every woman's. These studies and guidelines are intended to help you reach better informed decisions. They don't restrict access to screening.
Elizabeth Barrett (San Francisco)
@Paula Span But they might limit access in the future, depending on the transition of ‘recommends’ to ‘policy’. The insurance industry hangs it hat on policy, as we have all witnessed. Example: I have a terrible family history of female cancers (plural), but my new gynecologist (who Is now my old gynecologist after one visit) REFUSED to do a Pap test citing ACOG recommendations - recommendations for the patient at AVERAGE risk, not elevated risk as I am. I too would like to make my own healthcare decisions. If any reader believes I enjoy a Pap, think again. Think about the fact that I understand that early cancer intervention treatment saves lives. If a cancer surfaces, I want to be part of the statistic that certain testing saves lives.
bipzo (Manhattan)
How does Dr. Schonberg know that her grandmother was not saved by the two lumpectomies and 3 years of adjunctive endocrine therapy from a painful death from breast cancer with metastatic disease to the bones?
cornell (new york)
@bipzo Dr. Schonberg also does not know if the stress of undergoing multiple surgical procedures and side effects of hormonal therapy (there can be many) shortened her grandmother's life in addition to diminishing the quality of it. In some populations, screening is more likely to harm than to benefit. That's why it is so important to study it before reflexively telling people that earlier diagnosis is the only thing that matters.
T Avila (Boston)
I was diagnosed with breast cancer at age 70. I was thinking of following the protocol of every other year but I ended up going for the mammogram. I am glad I did - they caught it early enough. Still had a mastectomy because margins were not clear, but no chemo or radiation.
Sadie (Toronto)
My mother died of breast cancer at 89. I've personally known six women who had breast cancer in their 80's. Women should not "age out" of screening. Unless the intent is to just not bother to treat older women.
JudyH, Ph.D. (FL)
I had my first benign breast lump at age 17. It was the size of an olive. My family was in chaos at the time so I didn’t tell anyone for months. Fortunately I found a great surgeon at Johns Hopkins Hospital who I saw for years. I had two more benign lumps in my twenties and thirties. Then lots of cysts. And pain after using any estrogen product into my 50s. I am grateful for Breast Self Examination and my yearly mammogram, which might not be perfect but enough to reduce my anxiety. I will have my yearly mammogram for the rest of my life.
Knitter 215 (Philadelphia)
When we found my mom's new primary doc at the age of 91, she already had vascular dementia and a history of multiple strokes. When the PA asked what her goals for her life were, she answered to die and see her husband again. It shocked the PA, but made the rest of the discussion with the PCP easier. We decided that screening tests were not suitable for her - no more mammograms or colonoscopies because she wasn't strong enough to withstand the treatment. It was a wise decision for her.
Laura (Hoboken)
My grandmother ws advised in her 70's to ignore her skin cancer. WHen it grew to serious to ignore in her late 80's, she was also to old to endure the treatment. The delay stole her health and independence for her last few years. I wonder who funded this attempt to reduce the costs associated with finding and treating potential breast cancer? THat's one approach to reducing medical costs, a very bad one. Me, I'll keep getting my mammograms. Older women have higher risk of tumors.
Paula Span (New Old Age columnist)
@Laura The study was funded by grants from the National Institutes of Health. And it explores the benefits of risks of screening mammography, for women with no history of breast cancer and no symptoms. A different scenario from a woman, like your grandmother, who has cancer.
ARL (New York)
When are the vitamin D level vs cancer studies going to be completed? The correlation between low D and breast cancer is established; lets decide if D screening at 20, 25, and 30 would be more helpful than mammo in 40s. Women in their 40s at this time are throwaways if they show up for their first mammo and already are at stage 3.
Howard (Los Angeles)
What about women who do have a history of breast cancer? Or a family history of it? That's a lot of women. What are the statistics about mammograms on older women in those categories?
Eero (Somewhere in America)
My sister-in-law was advised that she only needed a mammogram every two years after she reached age 65. Her next mammogram, two years later, disclosed invasive ductal carcinoma. She has undergone surgery, chemo and radiation therapy, with results yet undetermined. She really wishes she had had the one year mammogram. Somewhere I read a statistic that 30% of breast cancer is diagnosed in women age 70 or older. You will never convince me that a simple and relatively inexpensive procedure should not be done on a yearly basis.
SW (Sherman Oaks)
@Eero The only person I know with bc is 77 and it started at 75... I think this recommendation is along the lines of -well you have to die of something - but you probably won’t die of this if you haven’t had it by 75.
LT73 (USA)
@Eero You point out a serious consideration, the cost and impact on thenpatient of treating cancer found a year later. Frankly I wonder how big the difference is in the number of screenings and the number with cancer for each decade of age, 40-49, 50-59, 60-69, 70-79, etc. And I also knew women who died before age 40 due to aggressive cancer found too late. In my opinion life is too important and valuable to be rationing care mainly to boost profits.
Helen Mrose (Severna Park MD)
The single most important risk factor for breast cancer (other than being female) is AGE. The statement "one in eight women will be diagnosed with breast cancer in her lifetime) is INCORRECT; it is "one in eight women who REACH 80 will be diagnosed with breast cancer". Mammography screening for women over the age of 75 can reduce morbidity - and likely mortality from the disease - and this is critically important. And by the way, breast imaging specialists recommend annual screening mammography beginning at at 40; the mortality reduction benefit has been proven repeatedly. Helen Mrose MD PhD Breast Imaging Radiologist
MUP (Port Washington NY)
@Helen Mrose Are we meant to believe that getting x-rayed year after year in the same place poses no health risk? Is all that exposure to radiation really harmless?
Pamela L. (Burbank, CA)
Why is it so easy to restrict this kind of test for older women? Do we restrict prostate testing for men over a certain age? As an older woman soon to enter her seventies, the prospect of this age restriction on mammograms is outrageous and probably made with saving money in mind for our healthcare insurance companies. Isn't it possible to get breast cancer at any age?
Paula Span (New Old Age columnist)
@Pamela L. Ms. L, these are not restrictions. They're guidelines. And because most women in these age brackets are Medicare beneficiaries, the profits of insurance companies are not at issue. And yes, similar guidelines cover other cancer screenings, including prostate screenings for men. Here is the U.S. Preventive Services Task Force recommendation for prostate screening, which similarly is not routinely recommended for men over 70 because the risks outweigh the benefits.
Helen Mrose (Park City, Utah)
@Pamela L. You are absolutely correct!
Pamela L. (Burbank, CA)
@Paula Span Ms. Span, I stand corrected. Thank you. However, I feel the suggestion of implementing these guidelines shows a certain degree of sexism and disregard for the overall health of older women. This will not change unless there are more women in power and more women speaking out.
ASZ (Westport, CT)
Think we have to remember who is offering the advice. It is likely an obstetrician/gynecologist who besides well women care of all ages, also sees women through pregnancy. Original Medicare only covers a visit to these practitioners once every other year. And their advice is remarkably consistent over time. Have a mammogram. With little in the literature, that's not surprising. And considering women's health needs and studies have frequently taken a back seat to those of men, probably will endure for a while longer.
Barbara Lee (Philadelphia)
“ 'It’s very difficult to tell someone in her 70s or 80s that we’re going to modify your treatment, or not treat you, because of the likelihood that something else will kill you before this cancer will,' Dr. Brawley said." And this is the core of the problem. Patients are ill-equipped to understand risk. Doctors are poorly trained to deal with uninformed patients and emotional issues, especially surrounding death. Thinking in terms of "we're going to beat this" isn't always helpful. We are all going to die. As patients and humans, we need to try to partner with the medical community to understand and pursue what constitutes "a good life" and "a good death" and if the medical community could drop the "life at all costs" mentality, that would be great too. It's hard because it requires individual thought and interaction. It's no longer a matter of stats. A POLST or advance directive is great if anyone looks at it. When a hospice nurse looks at you funny you continually repeat that your parent CAME HOME TO DIE and no longer needs a restricted diet, medication that has no palliative value, etc., you know the system isn't working.
Bruce Quinn (Los Angeles)
Medicare has a few newer preventive benefits written with age caps. Other preventive tests became law 30 years and the very simple legal benefit has no age cap. Legally, Medicare would pay for a mammogram if you were 120.
Zendr (Charleston, SC)
That would be the reason why the radiologist and breast surgeon both recommend continued screening ad infinitum. It’s like an endless source of revenue stream! Medicare for all indeed
Rich (Grove City, PA)
My mother was diagnosed with breast cancer in her seventies. She underwent surgery and lived into her nineties. The mammogram was probably a good thing to do.
Ellen Oliver (West Hartford)
@Rich Retired oncology nurse here, in my early 70s. I dealt mainly w/breast cancer patients. The problem is women will never know if the breast cancer will have any effect on their life expectancy. If your mother never had that mammogram, she well may have still lived into her 90s. I’m having one more & that’s it.
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