Are you old enough to give up your screening mammogram?

Most women don’t look forward to their routine mammogram, which can be uncomfortable and stressful. You may wonder: Is there an age when can you dispense with this regular chore? 75, 80, 85?

The truth is that experts haven’t determined a magic age when women no longer need breast cancer screening — largely because scientific evidence in this area is lacking, says Dr. Kathryn Rexrode, associate professor of medicine at Harvard Medical School and chief of the Division of Women’s Health at Brigham and Women’s Hospital. But many experts also agree that continuing mammography might not be the right choice beyond age 75. The real question, they say, is what is the right age for you to stop based on your individual needs? To decide, you need to understand both the potential risks and benefits of breast cancer screening.

Weighing the decision

Breast cancer is a disease that disproportionately affects older women, says Dr. Rexrode. About half of the women diagnosed each year are over age 60, and 20% are over age 70. “However, the rate of new cancers does seem to decline slightly in women over age 75,” she says. A 2012 study in the European Journal of Public Health found that some 3.3% of women over age 75 will be diagnosed with breast cancer. Of those women, one in three will die from the disease.

“Advantages of mammography include early detection of cancer, and this early detection may mean earlier access to treatments,” says Dr. Toni Golen, editor in chief of Harvard Women’s Health Watch.

In addition, breast cancers in older women are often easier to treat than those found in younger women. “Breast cancers in older women tend to be estrogen receptor–positive,” says Dr. Rexrode. This means that treatment won’t necessarily require chemotherapy, and doctors may be able to instead use hormone therapy, which most women tolerate well. Hormone therapy often involves a type of medication known as an aromatase inhibitor — such as anastrozole (Arimidex), exemestane (Aromasin), or letrozole (Femara) — which slows the body’s production of estrogen. Another option, tamoxifen (Nolvadex, others), prevents estrogen from entering and fueling growth in cancer cells.

Seeking breast cancer treatmentThe decision to have screening mammography isn’t the only one that women should revisit as they age. An older woman may also opt for different treatment options if she is diagnosed with breast cancer.Treatment decisions should be weighed carefully to preserve quality of life, says Dr. Kathryn Rexrode, associate professor of medicine at Harvard Medical School. Treatment should take into account how it will affect the person’s overall health and ability to function, she says. Will the treatment leave you better off, or worse? In light of other health conditions that might be present, an oncologist might want to try a different, potentially less aggressive treatment approach with older women who have breast cancer than with those who are younger.Treatment decisions should also factor in the physical effects of the cancer itself. A large tumor that spreads to other areas of the body and produces numerous symptoms may greatly reduce the quality of life, so preventing this situation may also be a reasonable goal.

Drawbacks to consider

Although screening mammograms certainly offer benefits for older women, particularly by revealing cancer at an early stage, there are risks to factor in to the equation as well. Among them are these:

The risk of false positives. “Mammograms are screening tests and are designed to detect as many cancers as possible. Screening tests have a certain number of false positives on purpose in order to catch as many cancers as we can,” says Dr. Golen. False positives (mammograms that look abnormal even when there’s no cancer) will trigger further testing or a biopsy — a procedure that some older patients may opt to avoid, she says. Even if this additional workup clears a woman of cancer, it still causes stress and physical discomfort. “Healthy women should weigh the benefit of possible early detection versus the stress of a possible false positive. Women with risk factors should follow the advice of their own physician,” says Dr. Golen.

The potential for overtreatment. Some early or precancerous conditions discovered by mammography may never become deadly, even if a woman lives with them for many years. “In some cases, you’re treating things that would never truly cause harm,” says Dr. Rexrode. These include ductal carcinoma in situ, a noninvasive cancer that has not spread outside the milk ducts (which may or may not become a life-threatening cancer); a precancerous condition called atypical hyperplasia; and breast calcifications, which are calcium deposits inside the breast that sometimes indicate cancer. Many women could potentially die with these conditions, not from them, says Dr. Rexrode. But treatment is usually recommended because doctors don’t yet have the ability to distinguish between those cases that present a danger and those that do not.

The creation of worry and stress. Mammography can be stressful, particularly when women are called back to examine abnormal findings. In addition, as noted above, these findings may prompt the need to undergo invasive diagnostic procedures, including biopsies, which sometimes turn out to be unnecessary.

The physical stress and side effects of treatments. Treating a cancer can require some combination of surgery (such as lumpectomy to remove a tumor or mastectomy to remove one or both breasts), radiation, or chemotherapy. While some older women can tolerate these treatments, others may not be willing or physically able to endure them.

“That doesn’t mean that we should never treat cancers in people in their 80s. We definitely do. But we need to consider the balance of side effects and benefits so that the treatment isn’t worse than the condition,” says Dr. Rexrode.

Is mammography right for you?Women mulling their options should ask themselves several questions to determine whether to continue screening mammography beyond age 75.Are you healthy? If you are in good health and anticipate living at least another 10 years, it may be worth continuing screening. If not, screening might not be the right choice.Are you willing to undergo additional diagnostic procedures? This could include additional imaging or even a biopsy to determine if you have breast cancer.Are you willing to undergo cancer treatments? Cancer treatments can be grueling, and not every woman wants to put herself through that. If a woman undergoes treatment for a stage 1 or stage 2 cancer, this may include a lumpectomy to remove the tumor followed by six weeks of radiation to prevent recurrence. She may need to go into a facility every day for radiation therapy, which can be a significant burden to both the patient and her family. “It can cause fatigue. It can cause local irritation,” says Dr. Rexrode, associate professor of medicine at Harvard Medical School. And it may affect how well you are able to function. “The benefits of undergoing this type of treatment are going to be different for a woman who’s 75, 80, or 85 than for a 50-year-old woman.”Are you physically able to endure diagnosis and treatment for breast cancer? Even if you are willing to be treated for breast cancer, you should also consider whether you have other health conditions that would make treatment too much of a challenge.Do you want to know that you have cancer? If you are not willing to undergo cancer treatment, getting screened for breast cancer may be an unnecessary emotional burden. “I don’t think anyone wants to know if she has cancer if she’s not going to do anything about it,” says Dr. Rexrode.

How the decision looks in real life

Ultimately, each woman will need to make the decision regarding screening mammography that best suits her needs (see “Is mammography right for you?”). A healthy 83-year-old woman who expects to live another 10 years and is willing to undergo not only the mammogram but also follow-up and cancer treatments, if needed, should continue to get mammograms as long as those factors don’t change. On the other hand, if you are in poorer health or just aren’t willing to endure screening and the procedures that might follow, it may be time to stop. It’s a discussion that you should have with your doctor.

The decision to stop screening isn’t always easy, even if there are numerous drawbacks to continuing. “For many women, mammograms are painful or carry a negative connotation, and these women may be more than happy to give them up.

Others see screening as part of taking care of themselves and don’t want to give it up,” says Dr. Rexrode. Even if you know that stopping screening is the right decision intellectually, it may be a hard one to make emotionally.

Bible verses for today’s meditation and inspiration: Matthew E. McLaren

And so we know and rely on the love God has for us. God is love. Whoever lives in love lives in God, and God in them. 1 John 4:16 NIV

Be completely humble and gentle; be patient, bearing with one another in love. Ephesians 4:2 NIV

We love because He first loved us. 1 John 4:19 NIV

Above all, love each other deeply, because love covers over a multitude of sins. 1 Peter 4:8 NIV

I pray that out of his glorious riches he may strengthen you with power through his Spirit in your inner being, so that Christ may dwell in your hearts through faith. And I pray that you, being rooted and established in love. Ephesians 3:16-17 NIV

And now these three remain: faith, hope and love. But the greatest of these is love. 1 Corinthians 13:13  NIV

Love must be sincere. Hate what is evil; cling to what is good. Romans 12:9 NIV

If I have the gift of prophecy and can fathom all mysteries and all knowledge, and if I have a faith that can move mountains, but do not have love, I am nothing. 1 Corinthians 13:2 NIV

Recommended contacts for prayer request and Bible study

www.agapetemplesda.com

www.adventistontario.org

https://www.hopechannel.com/au/learn/courses

breathoflife.tv/

https://3abn.org/all-streams/3abn.html

http://www.nadadventist.org/article/15/contact-us

https://www.adventist.org/en/utility/contact/

It Is Written

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