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Older Women Undergo Cancer Screening Regardless of Their Health

Patient age and life expectancy should determine whether to continue mammography and Pap testing.

For older women and women with limited life expectancy, the harm associated with breast and cervical cancer screening can begin to outweigh the potential benefit. To assess current cancer screening practices, researchers in California surveyed a population-based sample of 4792 older women (age, 70).

Most women (78%) reported undergoing screening mammography in the past 2 years. Reported screening rates decreased with advancing age (from 88% of 70- to 74-year-olds to 61% of those 85 or older). However, women with the worst health status were just as likely to be screened as those with the best health. Similarly, 77% of women reported undergoing Pap smears in the past 3 years, and 73% of these screened women reported having had three or more normal smears in the past 6 years. As with mammography, screening rates decreased with advancing age and did not decrease with worsening health status.

Comment: On the one hand, these self-reported rates of cancer screening are impressive. On the other hand, an editorialist wonders whether older women are being screened for the "right" reasons: Whether it's because women expect it or because they think it will keep them healthy, both are problematic. The evidence for a benefit of screening in this age group is limited at best, particularly for women in poor health. The survey results suggest that physicians and patients should consider health status when deciding whether to continue screening tests for breast and cervical cancer.

— Richard Saitz, MD, MPH, FACP, FASAM

Published in Journal Watch General Medicine May 18, 2004

Citation(s):

Walter LC et al. Relationship between health status and use of screening mammography and Papanicolaou smears among women older than 70 years of age. Ann Intern Med 2004 May 4; 140:681-8.

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• Medline abstract (Free)

Welch HG. Right and wrong reasons to be screened. Ann Intern Med 2004 May 4; 140:754-5.

• Original article (Subscription may be required)
• Medline abstract (Free)