Mammography screening in women over 80
Doctors are not doing enough to pick up on problems with excessive weight loss, says a Saint Louis University physician who helped draft recent guidelines to diagnose the condition called “cachexia” (kuh-kex-ee-uh). “In sick people, weight loss is an important indicator of disease and potentially impending death,” said John Morley, M.D., an endocrinologist and director
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A lack of clear-cut, scientific evidence illustrating the benefits of mammography screening in women over 80 has created a trail of controversy leading to a disturbing conclusion about cancer care in America.
“We are ill-prepared from a scientific knowledge perspective to provide cancer health care rationally, ethically, equitably and humanely to the ‘booming’ older population,” say two leading cancer researchers.
In an editorial published online in the Journal of Clinical Oncology ( JCO ), Jeanne S. Mandelblatt , MD, MPH, of Georgetown’s Lombardi Comprehensive Cancer Center, and co-author Rebecca Silliman, MD, MPH, PhD, of Boston University Medical Center, address the lack of scientific evidence available regarding cancer screening interventions for older Americans - an issue at the heart of a controversial breast cancer screening study published in the JCO earlier this year.
This study used observational data to provide evidence about the effectiveness of mammography screening in older women, in the absence of clinical trials.
In the current editorial, Mandelblatt and Silliman explore the study’s biases, all of which make screening seem more beneficial than it may actually be. If, as the editorial authors conclude, reduction in mortality is the appropriate metric to determine the effectiveness of screening then “at this time, we are left with the fact that there is no evidence that screening women 80 and older with mammography results in reductions in mortality.”
Mandelblatt and Silliman commend the study’s authors for raising difficult questions in gero-oncology especially when the answers are imperfect, but the authors draw attention to the broader problem related to care of older people.
“With continued gains in life expectancy and increases in cancer incidence with age, clinicians will be caring for an ever-increasing number of older individuals including the oldest old.”
Mandelblatt and Silliman recommend an investment in clinical trials specifically to assess cancer screening and treatment for older individuals, in order to strengthen the empirical data available to the medical community when making screening recommendations.
“Without a major shift in emphasis in clinical trials and new investments in understanding the impact of technology and downstream therapy on older populations, we will continue to practice in the context of limited trial evidence.”
Computer programs designed to help radiologists could identify more cases of breast cancer, but they might also increase the number of false-positive results, which can lead to biopsies in healthy women, according to a recent systematic review. Using computer-aided detection (CAD) mammography, “you do catch some cases that would have been missed if the mammogram
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Magnetic resonance imaging (MRI) alternated with mammography at six-month intervals can detect breast cancers not identified by mammography alone, a research team from The University of Texas M. D. Anderson Cancer Center will report at the 31st at the CRTC-AACR San Antonio Breast Cancer Symposium. MRI is known to be more sensitive in detecting breast
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According to researchers in Norway mammograms may detect some cancers that would have otherwise regressed. There has been a significant increase in breast cancer rates in some parts of Norway since women there began undergoing mammography every two years and the rates among regularly screened women have remained higher than rates among women of the
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Mammography and sonography findings help doctors identify and appropriately treat breast cancer in men, according to a study performed at the University of Texas M.D. Cancer Center in Houston, TX. Image findings from 57 male patients who were diagnosed with breast cancer were reviewed during the study. “The findings show that breast cancer in men
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Every day, women face a barrage of headlines about breast cancer. What should they do with all of that information? George Sledge, M.D., an internationally recognized breast cancer expert, pointed out that, despite all of the near-constant news and information about breast cancer, it is not the disease that impacts most women. “It’s important to
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