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Older women still need mammograms

January 24, 2019

Today’s column is different; it is highly personal. But, I believe that if it saves one woman from a breast cancer death, then it has done its job. I am writing this as I recover from outpatient surgery for very early stage breast cancer, recently discovered through a mammogram.

Mammograms, themselves unpleasant and not 100 percent perfect in identifying breast cancer, are still the best way to screen women for this disease. However, they are often not encouraged for women past age 75. This does a disservice to older women; they still need mammograms.

One rationale for not recommending mammograms for women over 75 seems to be that if you have lived three quarters of a century, don’t bother assessing potential breast cancer, since you may die from some other disease.

There is some valid concern that older women who have serious co-morbid diseases may not be able to physically handle the treatments necessary for any stage of cancer. Yet, many women of advanced age are still healthy and active; they need and deserve breast cancer screening mammograms and appropriate treatment. In the past month, I have heard from quite a few older women who have been treated for breast cancer and continue to be active and productive.

To me, it seems that there is some sexist thinking on this topic. When it comes to many other ailments and illnesses, the idea is to keep people alive and healthy regardless of age.

Last year, my husband, Maury, who was healthy but well past 75, developed back problems that could be remedied only by surgery. There was no question that he should receive the best treatment for his diagnosis, even though potential problems can follow such surgery and not everyone has a positive outcome as he had.

Decades ago, my father’s heart problems intensified. The heart surgeon reminded us of all the possible negative outcomes for an 85-year-old for this type of surgery; the operation might incapacitate my father more. After his recuperation, my father returned to his part-time work until age 90 and lived actively till age 96.

Since close to one in seven women will develop breast cancer at some point in their lives and it becomes more common with advancing age, it is distressing to see the current attitude towards mammograms for older women. Some of the medical field worry that there may be false positives, so that women may receive additional medical treatments that are unneeded, unpleasant and, for the insurance companies, expensive. Isn’t that true for most illnesses?

A 2011-12 National Cancer Institute study noted, “Early stage breast cancer in the older adult, as in the younger adult, is a curable disease in the overwhelming majority of patients. Almost 1.5 million women over age 65 in the United States are breast cancer survivors and over 820,00 of these women are age 75 and older.” These numbers are expected to be higher in more current studies. The median age at which breast cancer is diagnosed is 61, but 41 percent of these diagnoses are made in women 65 and older. Harvard’s online health page notes that “Although breast cancer is a leading cause of death in older women, women over 75 haven’t been included in studies of mammography. However, there is evidence that most breast cancers detected in older women are relatively slow growing and easily treated.”

The bottom line seems clear. Women, if you are in good or fairly good health and over 75, keep getting those yearly mammograms. I’m certainly glad I did.

Diane W. Mufson is a retired psychologist. Her email is dwmufson@comcast.net

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