Hello bOObs Bloggettes:
I’ve blogged about this before, but I found some new info in an old NYT article that my 96 year old mother cut out for me so I thought I’d share it.
Like most things having to do with breast cancer (BC) screening, info on the subject of when women should stop screening is all over the map.
When the science started to turn to a negative regarding BC screening (the reason that they changed the screening guidelines for women in 2009), the first group to get cut off the list was women ages 75 and older. One oncologist says this: “This is an area with a complete lack of randomized clinical trials.” And of course trials is what “evidence-based medicine” relies on with regards to its science and creating its Standard of Care for diagnosing and treatment parameters.
Further, the NYT article stated, “Breast cancer studies, like medical research in general, have often excluded older subjects. So the data on whether mammography improves survival is very limited in women ages 70 to 74, and nonexistent for those 75 and older.”
This may be due to increased mortality at that age. Or maybe they think it might skew their study findings? Hard to know.
Regardless, “That’s why the independent U.S. Preventative Services Task Force [USPSTF] has concluded that while having mammograms every other year improves survival for women ages 50 to 74, there’s ‘insufficient’ evidence to assess their use for those over 75.”
Of course I would argue that there’s that much to be gained by using a mammogram at any age to screen for BC because, as I’ve mentioned repeatedly in my blogs, oftentimes more harm is done to women using this device than not screening at all or using another device like ultrasound (if you have dense breasts). And thermography should be thrown into the mix as well, which could help find precancerous conditions which would be fantastic (see previous blog).
The USPSTF, after reading a large review of the medical literature on mammography undertaken by the Nordic Cochrane Centre, did their own research and decided the Centre had made some sound conclusions in thinking that more harm was being done than good using this device for many if not most women. And hence, they changed their guidelines, which created a domino effect on cancer interest groups such as the American Cancer Society changing its guidelines…and it went from there.
Even so, the article continues, “Yet more than half of women over 75 have had a screening mammogram (a test for individuals with no history or symptoms of breast cancer) within the past two years, the Centers for Disease Control and Prevention [CDC] reported in 2018.”
I suspect this is largely due to the confusion over whether to screen or not, with both doctors and patients left in a quandary. And docs are always concerned with malpractice and CYA so they go ahead and recommend. But the other thing not to be overlooked is that doctors have pressure put on them from various angles, some from their assorted associations, some from their hospital heads and medicine conglomerates — and then there’s the incentives that many of them receive for writing out prescriptions for things such as mammography (see previous blog). So it’s impossible to know.
Dr. Otis Brawley, former medical director for the Am. Cancer Society (and a brilliant man I interviewed for my films) said this in the article: “…the most important thing we can do is get people to understand what the questions are, and to understand that nobody has the exact answers.”
Amen.
Here’s a link to the article (hopefully you won’t need a subscription to see it): www.nytimes.com/2020/03/16/health/breastcancer-elderly-old-age.html
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Stay healthy,
Megan
Megan Smith, M.S.
Director, bOObs: The War on Women’s Breasts
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