Booster Shots

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Another example of over-screening for breast cancer

December 15, 2009 |  7:00 am

Cancer screening isn’t for everybody. As Dr. Stephen Taplin, chief of the Applied Cancer Screening Research Branch at the National Cancer Institute in Washington, D.C., once put it to me, “If I knew I was going to get struck by lightning tomorrow and die, there’s no way I’d spend today getting a colonoscopy.”

Mammo In that vein, one of the upsides of suffering a heart attack or stroke is that the urgency for getting a mammogram declines. A group of researchers from Emory University checked out whether women recognized this silver lining.

The trio used Medicare data to identify women over age 66 who were in the habit of getting annual mammograms. They included women with no history of breast cancer who had two exams within a 7- to 15-month period. Of those 25,884 women, 1,239 went on to suffer a “serious health event” in the following 11 months. And indeed, fewer of these women continued their annual mammograms compared with their cohorts who remained healthy.

Still, the researchers were surprised that so many women – who were already in their late 60s or older – continued to get screened after a health event that reduced their average life expectancy. For instance, women who were diagnosed with a late-stage cancer were only 26% less likely to keep up with their mammograms compared with their healthy peers. Having a heart attack reduced the chances of getting a mammogram by 36%, and a stroke knocked it down by 41%, according to a research letter in today's issue of Archives of Internal Medicine.

“Not all women who experience severe health events ought to discontinue screening, but these data, combined with what we know about rates of overdiagnosis, suggest that many women continue screening past the point where it offers much benefit,” said lead researcher David Howard of Emory’s Department of Health Policy and Management. “The idea that it might make sense to stop screening at some point does not register with a large segment of the population.”

He noted that the new guidelines from the U.S. Preventive Services Task Force included the suggestion that women stop getting routine mammograms after age 75. However, he said that idea “kind of flew under the radar” while debate raged about the appropriateness of starting routine screenings at 50 instead of 40.

-- Karen Kaplan

Photo: If you knew you’d get hit by lightning tomorrow, would you get a mammogram today? Photo credit: John T. Barr/Reuters