Pap smears, mammography should be targeted at healthy elders, study says

Pap smears and mammography screening should be targeted at healthy older women and avoided by older women in poor health, in whom risks of screening outweigh potential benefits, according to a study by UCSF researchers at the San Francisco Veterans Affairs Medical Center (SFVAMC).

The study, published in the May issue of Annals of Internal Medicine, examines how age and health status affect screening mammography and Pap smear rates among women over the age of 70.

"The good news is that the rates of screening mammography and Pap smears have really increased in healthy older women," says lead researcher Louise C. Walter, MD, UCSF assistant professor of medicine in the geriatrics division at SFVAMC. "The problem is that there is still a population of very healthy older women who are not being screened who should be. And there's a population of very sick elderly women who are getting screened when they shouldn't be."

Walter and her colleagues analyzed data from 4,792 women age 70 or older who took part in the 2001 California Health Interview Survey. The women rated their overall health and functioning using a standard scale.

Of the women surveyed, 78 percent reported a recent mammogram and 77 percent said they had recently had a Pap smear. Overall screening rates decreased with advancing age. However, women with the worst health indicators continued to get screened as much or more than those considered the healthiest.

For women with life expectancies of less than five years, the potential risks of screening tests may greatly outweigh the potential benefits, Walter says. Such risks include unnecessary tests due to false-positive results, identification and treatment of clinically insignificant disease and psychological distress.

"You have to balance the potential risk of developing a symptomatic cancer versus the risk of having side effects from the procedure," says Walter.

While organizations such as the American C

Contact: Joan Aragone
University of California - San Francisco

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