"Mammograms? Oh, I don't get those any more," my mother told me. "I told the doctor I didn't need them."
Her comment shocked me at first. I take the need for my annual mammogram as an article of faith. Finding breast cancer early will spare me extensive treatments and add years to my life. But will I feel the same way when I'm 88 like my mother was when she made this statement to me? Maybe not.
My mother is very clear in her own mind that if she were diagnosed with breast cancer, she would not do radiation or chemotherapy. So if she has breast cancer, she would just as soon not know about it. Of course, I am thinking, "But Mom, suppose the mammogram found a tiny cancer that could be treated with a lumpectomy?"
This topic is a complicated one. What is the age when one goes from being old to being very old? Is there an age when one is too frail for treatment or too old to still have life goals left to accomplish? The answer seems to vary from person to person. Some women are there by age 75. My very spry Aunt Pearl has not yet reached that point at 95.
The American Cancer Society says, "There is no fixed age at which women should stop getting mammograms. Mammograms for older women should be based on the woman's health and whether or not she has other serious illnesses. Age alone should not be the reason to stop having regular mammograms. As long as a woman is in good health and would be a candidate for treatment if she developed breast cancer, she should continue to have screening mammograms."
Age is a major component of breast cancer risk. Women between the ages of 60-90 have an 8.59% risk of getting breast cancer, but some data suggests that after age 85, the risk begins to drop off. However, conclusive statistics are hard to come by in the over 85 age group and complicated by the frequency of other health issues in this population.
looked at 49,616 women 67 and older and found that women over age 80 were more likely to be treated with surgery alone even if their type of cancer would usually be treated more aggressively in younger women. They also found a higher mortality rate in the older women. The study concluded, "Women age 80 years have breast cancer characteristics similar to those of younger women yet receive less aggressive treatment and experience higher mortality from early-stage breast cancer. Future studies should focus on identifying tumor and patient characteristics to help target treatments to the oldest women most likely to benefit."
A 2008 study that looked specifically at whether mammograms were useful found that older women who had regular mammograms had a lower mortality rate from breast cancer than those who had never had a mammogram, but these results were complicated because they also found that women who were getting regular mammograms were healthier than those who did not. In the end, the authors of the study could not demonstrate that mammograms in women over 80 improved survival.
The study's senior author, Dr. Gildy Babiera says, "Finding breast cancer early in this age group may not result in survival benefit and it may even increase unnecessary angst in elderly women with other ailments. On the other hand, if the woman is otherwise healthy and could be a surgical candidate, should breast cancer be found by a routine mammogram, perhaps she could be offered less invasive treatment and spared from toxic therapies given to women diagnosed with advanced breast cancer."
I wish my mother would reconsider her decision to stop mammograms. If a mammogram could find a tiny cancer that could be treated with surgery, maybe she would be spared the suffering that would accompany metastasis to a distant organ. But my mother has her own mind and has been making responsible decisions since long before I was born.
There comes a time when mammograms may not be useful any more. However, we still don't know exactly where that point it. I suspect that point will never be a specific age, but a time when a woman's health and personal life expectancy make a mammogram a needless stress. For daughters, sisters, and friends, allowing the older women we love to decide to discontinue mammograms may be hard, but we need to respect their informed decisions.