There are no universal recommendations for routine mammograms in women over age 70. That’s because we don’t have robust mortality data from mammogram use in this population. And so, older women are advised to make their own individual decisions about mammogram along with their doctor, based on other medical issues, life expectancy and health beliefs.
But do women have the information they really need to be deciding this question?
That’s what researchers at the University of Sydney asked when they did a study to determine what would happen if they gave women over age 70 Decision Aids (simple, visual aids) to inform their decision about having screening mammograms.
Here is an example of a decision aid. It visually represents the risk in 1,000 women over age 70 of being diagnosed with breast cancer over the next 10 years (brown boxes) if you do (right group) or don’t (left group) have a mammogram, as well as the chance you’ll have an unnecessary biopsy as a result of a false positive mammogram (dark purple boxes on the right).
The researchers found that while the women using Decision Aids made more informed decisions about having mammograms, the information did not impact the rate of mammogram use in the study population. There was an impact in that undecided women tended to get off the fence and make a choice, and women felt less anxiety and insecurity about the choice they made.
So, for most women, what Decision Aids do is make them feel better about their choices. Which says to me that most patients (and I suspect, doctors) make pre-determined decisions about mammography based on factors unrelated to the statistics of outcome, but use those statistics to support their beliefs, whichever way they decide.
Sort of like politics.
But unlike politics, those designing the decision aids are not trying to move votes, they’re trying to help you find the choce that’s right for you. If you’re undecided, or ucomfortable with your choice, a decision aid may be just the right thing for you.
Now if someone would just come up with a decision aid for the 2008 elections…
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The researchers are conducting a similar but web-based trial for younger women (over age 40). If you want to participate, or see what a decision aid is, click on the link below.
http://www.mammogram.med.usyd.edu.au/
It’s really interesting, I encourage you to do it. See if it changes your choice about mammogram or not. Or just makes you feel better about your choice.
Wow, what a FANTASTIC resource!
It’s interesting that the Australian recommendation for women 50-60 is every 2 years, while the recommendation around here (upper US midwest, with insurance) is every year starting at 40.
Is there evidence of any risk from 30 years of yearly mammograms (following the recommendations around here, starting at 40 and going through 70)? That is, is there any evidence that the radiation from 30 years of mammograms (including, likely, at least some extra mammograms?)
Do biopsies (or whatever) done that end up being negative affect the reliability of later mammograms? Cause other problems?
Thanks, I wish I’d seen this decision tree thing a LONG time ago!
I’m in my mid 40s. Had a baseline mammo at 40, then decided not to repeat until I get to 50. (I’m not high risk).
Doing the risk assessment helps me support my decision.
My friend works at a tertiary facility and is always telling me about the young women she sees who have aggressive breast CA… still doesn’t make me want to start screening early.
CardioNP
Bardiac, here is the article on the decision aid for mammograms for all women from the same author (Alexandra Barrett) as in the referenced article. She uses somewhat higher mortality reduction numbers than the accepted percentage, but I find it still interesting.
One other thing. The article I referenced also uses European data for false positives from biennial screening. American numbers for false positives (and probably for overdiagnosis as well) are considerably higher.