More access to health care may lead to unnecessary mammograms
Researchers have concluded that providing better access to health care may lead to the overuse of mammograms for women who regularly see a primary care physician and who have a limited life expectancy.
The cautionary note from researchers at the University of Texas Medical Branch at Galveston is that screening women in this category could subject them “to greater risks of physical, emotional and economic suffering.”
Dr. Alai Tan, a senior biostatistician in UTMB’s Sealy Center on Aging and lead author of the study, said that “there has been little systematic attempt to define guidelines that would help determine when breast cancer screening might not be appropriate or overused.
“The American Cancer Society guidelines on screening, for example, have had no upper age limit,” Tan wrote in the study. “This is different from the case with prostate-specific antigen screening, where both the American Cancer Society and the American Urological Association have longstanding guidelines that exclude men with a less than 10-year life expectancy.”
The study was published in the June edition of Medical Care, the official journal of the Medical Care Section of the American Public Health Association.
Using data from 2006 through 2009, researchers studied about 5 percent the Medicare claims filed during that period by women whose life expectancy was less than seven years. They further studied where the women lived and whether they had a primary care physician.
Mammograms Linked With Unnecessary Breast Cancer Treatment: Study
Mammograms have done surprisingly little to catch deadly breast cancers before they spread, a big U.S. study finds. At the same time, more than a million women have been treated for cancers that never would have threatened their lives, researchers estimate.
Up to one-third of breast cancers, or 50,000 to 70,000 cases a year, don’t need treatment, the study suggests.
It’s the most detailed look yet at overtreatment of breast cancer, and it adds fresh evidence that screening is not as helpful as many women believe. Mammograms are still worthwhile, because they do catch some deadly cancers and save lives, doctors stress. And some of them disagree with conclusions the new study reached.
But it spotlights a reality that is tough for many Americans to accept: Some abnormalities that doctors call “cancer” are not a health threat or truly malignant. There is no good way to tell which ones are, so many women wind up getting treatments like surgery and chemotherapy that they don’t really need.
Men have heard a similar message about PSA tests to screen for slow-growing prostate cancer, but it’s relatively new to the debate over breast cancer screening.
“We’re coming to learn that some cancers - many cancers, depending on the organ - weren’t destined to cause death,” said Dr. Barnett Kramer, a National Cancer Institute screening expert. However, “once a woman is diagnosed, it’s hard to say treatment is not necessary.”
In general, the researchers found that the use of mammograms decreases as a woman’s life expectancy grows smaller. However, they found that the general downtrend as a woman ages could be offset by better access to health care.
For example, the screening rate for woman with a life expectancy of less than six years who had seen a primary care physician two or fewer times during the three-year period studied was about 20 percent. However, among women who had seen a primary care physician 13 or more times during that period who had a life expectancy of less than four years, the rate was about 34 percent.
The researchers also noted that there is about a four-year difference from when a cancer is diagnosed via screening and when it would be diagnosed clinically for women between 65 to 74. Previous studies have demonstrated that “survival benefits” were not apparent seven to 10 years after a screening.
The study also found that women with a limited life expectancy who lived in an area with greater access to mammography resources, more primary care physicians, mammographic facilities and radiologists, were more likely to be screened.
Mammograms have been heavily promoted for about 25 years and many patients have come to expect that a screening test such as this would be a routine procedure, the researchers wrote. The researchers concluded that life expectancy should be a factor in deciding whether a mammogram is needed.
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Other authors of the study are UTMB’s Director of Biostatistics Yong-Fang Kuo and UTMB’s Vice President and Chief Research Officer Dr. James Goodwin.
Funding for the study was provided by the Cancer Prevention Research Institute of Texas and the National Institutes of Health.
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Raul Reyes
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409-747-0794
University of Texas Medical Branch at Galveston