Task force: Mammograms an option at 40, do more good at 50

Mammograms do the most good later in life, a government task force said Monday in recommending that women get one every other year starting at age 50, and that 40-somethings make their own choice after weighing the pros and cons. 

Mammograms do the most good later in life, a government task force declared Monday in recommending that women get one every other year starting at age 50. It said 40-somethings should make their own choice after weighing the pros and cons.

13 jan 2016--When to start routine mammograms and how frequently to get them has long been controversial. The latest guidelines from the U.S. Preventive Services Task Force stick with its advice that women should one every two years between ages 50 and 74. But they also make clear that it's an option for younger women even though they're less likely to benefit.
Some health groups urge mammograms every year starting at 40—although last year the American Cancer Society upped its starting age to 45.
There is some common ground emerging, that mammography advice shouldn't always be one-size-fits all. "Age 50 isn't magic," said task force past chairman Dr. Michael LeFevre of the University of Missouri.
Here are some things to know about mammograms.
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WHAT THE TASK FORCE SAYS
Women in their 60s are the most likely to avoid dying from breast cancer thanks to mammograms, but there's clearly enough benefit for the average woman to start at 50, the task force found.
The advisory group wants younger women to understand the trade-offs before deciding: Among every 1,000 women screened, one additional death could be prevented by starting mammograms at 40 instead of 50. But there would be 576 more false alarms and 58 additional unneeded biopsies. Also, two extra women would be overdiagnosed, treated for cancer that never would have become life-threatening.
Monday's update, published in Annals of Internal Medicine, is largely a rewording of guidelines originally issued in 2009 and reconsidered in draft form last spring. This time, the task force stresses that "we think the science supports a range of options" for 40-somethings, LeFevre said.
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DIFFERING GUIDELINES
Mammograms aren't perfect, and different health organizations weigh the trade-offs differently. So do women and their physicians.
The American Cancer Society says to begin annual mammograms at 45 but switch to every other year at 55. After menopause, tumors tend to grow more slowly and women's breast tissue becomes less dense and easier for mammograms to penetrate, says chief medical officer Dr. Otis Brawley. Between ages 40 and 44, when breast cancer is especially uncommon, the society also says women should make their own choice.
"We're moving away from paternalistic medicine where we doctor organizations used to tell women, 'You must do this,'" Brawley said. "We're saying, 'This woman is at higher risk, therefore maybe she should get screened at 40. This woman is at lower risk, maybe she can wait a little later.'"
The American College of Obstetricians and Gynecologists stands by annual mammograms starting at 40, while urging patient education and shared decision-making.
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THINGS TO CONSIDER
More than 200,000 women are diagnosed with breast cancer each year, and about 40,000 die from it. It is most frequently diagnosed among women ages 55 to 64, and the median age of death from breast cancer is 68.
Women with a mother, sister or daughter with breast cancer have a higher risk than the average 40-year-old. Other factors can play a role, too, including genetics, breast density and menstrual and pregnancy history.
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PERSONALIZED SCREENING
Dueling guidelines mean "some people get so confused they don't get screened at all. Some are too anxious or afraid not to do more, and it may not be better for them," said breast cancer specialist Dr. Laura Esserman of the University of California, San Francisco. "Maybe we should be screening in a new way."
Esserman leads the first-of-its-kind WISDOM study that soon will begin enrolling 100,000 women to test whether tailoring screening to someone's individual risk is better than age-based mammograms. Women given annual mammograms starting at 40 will be compared with others assigned more or less frequent screenings, starting at different ages, based on in-depth risk assessments.
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INSURANCE COVERAGE
Insurance usually pays for mammograms. Because of concern about how the task force recommendations might be implemented, Congress recently extended for two years legislation preserving access to routine mammograms without copays starting at age 40.
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WHEN TO STOP
The task force says more research is needed to know whether to continue mammograms at 75 and beyond. The cancer society says to keep screening as long as women are in good health and have a life expectancy of at least 10 years.
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WHAT'S NEXT
The task force said more research is needed to tell if newer 3-D mammograms should be used for routine screening and if women with dense breasts benefit from extra testing, such as with ultrasounds or MRIs.
The cancer society's Brawley said the mammogram age argument has distracted from a bigger urgency: "We ought to say this more: We need a better screening test for younger women."
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Online:
Task Force: www.screeningforbreastcancer.org
WISDOM study: www.wisdomstudy.org

New study suggests benefits of regular mammography extend to the elderly

Breast cancer is the second most common cancer in women after skin cancer and occurred in 230,000 women in the United States in 2015. Breast cancer afflicts 1 in 8 women in their lifetime and 1 in 25 die from this disease. Although a number of randomized trials demonstrate the clear benefits of mammography screening in women up to age 74 on reducing mortality, data are sparse in women over the age of 74, especially minorities. In 2010, 41 percent of breast cancer deaths occurred in the more than 19 million women who are between the ages of 65 to 84 years.

07 jan 2015--In a new study published in the American Journal of Medicine, Charles H. Hennekens, M.D., senior author and first Sir Richard Doll Professor and senior academic advisor to the dean in the Charles E. Schmidt College of Medicine at Florida Atlantic University, indicates that black and white women ages 75 to 84 years who had an annual mammogram had lower 10-year breast cancer mortality than corresponding women who had biennial or no/irregular mammograms.
Among elder women, the American Cancer Society and the United States Preventive Services Task Force recommend regular mammography for ages 65 to 74.
Although many guidelines rely on self-reports, Hennekens and his collaborators from Baylor College of Medicine and Meharry Medical College, used the Surveillance, Epidemiology, and End Results (SEER) program file linked to the Medicare administrative claims file, which allowed them to identify screening mammography use from 1995 to 2009 from 64,384 non-Hispanic women (4,886 black and 59,498 white). These linked files also permitted them to explore breast cancer mortality differences between elderly black or white women who self-selected for regular annual or biennial mammography screening. The researchers selected 69 as the lower age limit because Medicare coverage of the general population begins at age 65, and the exposure of interest was regular mammography screening in the four years immediately preceding breast cancer diagnosis.
Three mutually exclusive categories were defined: no or irregular mammography; biennial mammography; and annual mammography. They looked at data from non-Hispanic, white or black women; Hispanics were not included because Hispanic white women have substantially lower mortality than non-Hispanic whites, and the number of Hispanic blacks is small. The researchers also measured socioeconomic status looking at median household income, the percentage of individuals living below the poverty level, and whether or not they had a high school education.
Other significant findings from the study show that:

• White women who had died tended to be older, to have a later stage diagnosis, to have received chemotherapy, and to have a higher socioeconomic status.
• White women who died were less likely to have undergone surgery and receive radiation therapy.
• Similar characteristics were seen in black women as in white women.
• 69- to 84-year-old women receiving regular annual screening mammography during the four years immediately preceding breast cancer diagnosis had consistently lower five-year and 10-year risks of breast cancer mortality thanwomen with no or irregular screening regardless of race.
• 10-year risks were more than three times higher among white and more than two times higher among blacks aged 69 to 84 years with no or irregular screening compared with annual screening.

Hennekens notes that further research is needed, but that in the future, the use of regular claims-based surveillance for mammography as a source of data may offer some unique advantages over self-reports.
From 1995 to 2005, according to Science Watch, Hennekens was the third most widely cited medical researcher in the world and five of the top 20 were his former fellows and/or trainees. In 2012, Science Heroes ranked Hennekens No. 81 in the history of the world for having saved more than 1.1 million lives, which placed him two ahead of professor Jonas Salk ranked No. 83 for the development of the polio vaccine. In 2013, he received the "Fries Prize for Improving Health" and in 2014, he received the Alton Ochsner Award for his pioneering work on smoking and health. In 2015, he was ranked the No. 14 "Top Scientist in the World" based on his H-index of 173.


Provided by Florida Atlantic University

Mammography benefits women over 75

This bar graph shows the change in detection method over time (1990-2011) for breast cancer cases in patients aged 75 years and older (n = 1162). Pt/PhysD = detection by patient or physician. Credit: Radiological Society of North America

10 aug 2014--Mammography-detected breast cancer is associated with a shift to earlier stage diagnosis in older women, subsequently reducing the rate of more advanced, difficult-to-treat cases, according to a new study published online in the journal Radiology. Researchers said the findings lend support to regular mammography screening in women ages 75 and older.

The value of mammography screening in older women has been subject to much debate in recent years. The American Cancer Society recommends annual mammograms for women age 75 and older as long as they are in good health, while the U.S. Preventive Services Task Force (USPSTF) does not recommend mammography screening in this age group, citing insufficient evidence to evaluate benefits and harms.

A lack of research is chiefly responsible for the divergent recommendations, according to Judith A. Malmgren, Ph.D., affiliate assistant professor at the University of Washington's School of Public Health and Community Medicine in Seattle.

"There are no studies on women age 75 and older, despite the fact that they are at the highest risk for breast cancer," she said.

Dr. Malmgren and her research partner, Henry Kaplan, M.D., from the Swedish Cancer Institute in Seattle, recently looked at the impact of mammography detection on older women by studying data from an institutional registry that includes more than 14,000 breast cancer cases with 1,600 patients over age 75.

This graph shows the change in stage over time (1990-2011) for breast cancer cases in patients aged 75 years and older (n = 1162). Credit: Radiological Society of North America

The majority of mammography-detected cases were early stage, while physician- and patient-detected cancers were more likely to be advanced stage disease. Mammography-detected invasive breast cancer patients were more often treated with lumpectomy and radiation and had fewer mastectomies and less chemotherapy than patient- or physician-detected cases.

Mammography detection was associated with a 97 percent five-year disease-specific invasive cancer survival rate, compared with 87 percent for patient- or physician-detected invasive cancers.

"Mammography enables detection when breast cancer is at an early stage and is easier to treat with more tolerable options," Dr. Malmgren said. "In this study, older women with mammography-detected invasive cancer had a 10 percent reduction in breast cancer disease-specific mortality after five years."

The early detection provided by mammography is particularly important in older women, Dr. Malmgren noted, because they cannot easily tolerate the chemotherapy that is commonly used to treat more advanced breast cancers.

"Longer life expectancies for women also increase the importance of early detection," Dr. Malmgren said. "A 75-year-old woman today has a 13-year life expectancy. You only need five years of life expectancy to make mammography screening worthwhile."

Dr. Malmgren acknowledged that the potential costs of mammography, such as those associated with false-positive results, are an important consideration when weighing screening benefits. However, she said that false-positive findings are less common in older women.

"It's easy to detect a cancer earlier in older women because breast density is not an issue," Dr. Malmgren said. "And mammography is not expensive, so doing it every other year would not add a lot of cost to healthcare."

The researchers hope that the study results help women and their physicians make better informed decisions about mammography, ultimately leading to lower mortality rates.

"Breast cancer survival in younger women has improved dramatically over last 20 years, but that improvement has not been seen in older women," Dr. Malmgren said.

More information: "Improved Prognosis of Women Aged 75 and Older with Mammography-detected Breast Cancer." Radiology, 2014.

Provided by Radiological Society of North America

USPSTF mammography recommendations will result in countless unnecessary breast cancer deaths each year

Reston, Va.17 nov 2009 — If cost-cutting U.S. Preventive Services Task Force (USPSTF) mammography recommendations are adopted as policy, two decades of decline in breast cancer mortality could be reversed and countless American women may die needlessly from breast cancer each year. The recommendations ─ created by a federal government-funded committee with no medical imaging representation ─ would advise against regular mammography screening for women 40-49 years of age, provide mammograms only every other year for women between 50 and 74, and stop all breast cancer screening in women over 74.

"These unfounded USPSTF recommendations ignore the valid scientific data and place a great many women at risk of dying unnecessarily from a disease that we have made significant headway against over the past 20 years. Mammography is not a perfect test, but it has unquestionably been shown to save lives ─ including in women aged 40-49. These new recommendations seem to reflect a conscious decision to ration care. If Medicare and private insurers adopt these incredibly flawed USPSTF recommendations as a rationale for refusing women coverage of these life-saving exams, it could have deadly effects for American women," said Carol H. Lee, M.D., chair of the American College of Radiology Breast Imaging Commission.

Since the onset of regular mammography screening in 1990, the mortality rate from breast cancer, which had been unchanged for the preceding 50 years, has decreased by 30 percent. Ignoring direct scientific evidence from large clinical trials, the USPSTF based their recommendations to reduce breast cancer screening on conflicting computer models and the unsupported and discredited idea that the parameters of mammography screening change abruptly at age 50. In truth, there are no data to support this premise.

"The USPSTF claims that the "harms" of mammography, including discomfort of the exam, anxiety over positive results, and possibility of overtreatment because medical science cannot distinguish which cancers will become deadly most quickly ─ outweigh the greatly decreased number of deaths each year resulting from breast cancer screening. Without doubt, the possibility of having one's life saved through early detection far outweighs any of these concerns. Their premise is tragically incorrect and will result in many needless deaths if their recommendations are adopted by the American public." said Lee.

"The USPSTF recommendations are a step backward and represent a significant harm to women's health. To tell women they should not get regular mammograms starting at 40 when this approach has overwhelmingly been shown to save lives is shocking. At least 40 percent of the lives saved by mammographic screening are of women aged 40-49. These recommendations are inconsistent with current science and apparently have been developed in an attempt to reduce costs. Unfortunately, many women may pay for this unsound approach with their lives," said W. Phil Evans, M.D., FACR, president of the Society of Breast Imaging (SBI).

The USPSTF is an independent panel of primary care physicians funded and staffed by the HHS Agency for Healthcare Research and Quality (AHRQ). The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) gave HHS the authority to consider USPSTF recommendations in Medicare coverage determinations for additional preventive services. Recently, Congress has expressed their desire to broaden this authority and enhance the role of the USPSTF in terms of its impact on coverage for existing services. Additionally, private insurers may incorporate the AHRQ-funded USPSTF recommendations as a cost-savings measure.

"I am deeply concerned about the actions of the USPSTF in severely limiting screening for breast cancer. These recommendations, in combination with recent CMS imaging cuts, jeopardize access to both long proven and cutting-edge diagnostic imaging technologies. Government policy makers need to consider the consequences of such decisions. I can't help but think that we are moving toward a new health care rationing policy that will turn back the clock on medicine for decades and needlessly reverse advances in cancer detection that have saved countless lives," said James H. Thrall, M.D., FACR, chair of the American College of Radiology Board of Chancellors.

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To speak to an ACR spokesperson, please contact ACR Director of Public Affairs Shawn Farley at 703-869-0292 or sfarley@acr-arrs.org.

Dense breasts found in many older women, too

NEW YORK, 02 may 2009- In general, a woman's breasts get less dense as she ages. However, a new study shows that there remain a substantial proportion of older women with very dense breasts -- a finding that could have important implications for breast cancer screening.

Dense breast tissue can cloud tumors on mammography. "Our data," Dr. Freya Schnabel from NYU Cancer Center in New York, told Reuters Health, "would suggest that mammographic density, in conjunction with age and overall breast cancer risk assessment, should be considered when assessing the potential benefit of other imaging studies in addition to yearly mammography."

Prior research has linked having dense breasts to a 4- to 6-fold increased risk of developing breast cancer, compared to women with less dense breasts. Moreover, dense breasts may impair the sensitivity of screening mammography, as mentioned. Younger age is a well-known correlate of dense breasts, whereas the percentage of older women with dense breasts is unknown.

To investigate, Schnabel's team analyzed data from 500 consecutive patients who had annual screening mammography and were entered in the NYU institutional radiology database.

Overall, 4 percent of women were younger than 40 years of age, 27 percent were 40 to 49 years, 30 percent were 50 to 59 years, 24 percent were 60 to 69 years, 9 percent were 70 to 79 years, and 6 percent were 80 years and older.

As expected, breast density was highest in younger women. Among women in their 40s, for instance, 74 percent had dense breasts.

Nonetheless, dense breasts were still common among older women. Dense breasts were seen in 54 percent, 42 percent, and 31 percent of women in their 50s, 60s, and 70s, respectively.

The findings were presented at the 10th annual meeting of the American Society of Breast Surgeons in San Diego, California.

Mammography Benefits High-Risk Women in Late 30s

Breast cancer mortality reduction outweighs radiation-induced risk in BRCA carriers

02 feb 2009 -- For women carrying mutations in the BRCA gene, who are advised to begin mammography screening at as early as 25 to 30 years of age, the reduction in breast cancer mortality outweighs the risk of radiation-induced cancer mortality in women screened annually at 35 to 39 years of age but maybe not younger age groups, according to the results of a study published in the Feb. 4 issue of the Journal of the National Cancer Institute.

Amy Berrington de Gonzalez, from the Johns Hopkins Bloomberg School of Public Health in Baltimore, and colleagues developed a model to estimate the lifetime risk of radiation-induced breast cancer from mammography screening in young women (under 40 years old) carrying BRCA mutations, then estimated reduction in breast cancer mortality due to mammography compared with radiation risk.

The researchers found that the lifetime risk of radiation-induced breast cancer mortality due to annual mammography fell with increasing age at screening, from 26 per 10,000 women screened from 25 to 29 years old to 13 per 10,000 women screened from 35 to 39 years old. The reduction in breast cancer mortality needed to outweigh this risk also decreased with increasing age at screening, from 51 percent at 25 to 29 years of age to 4 percent at 35 to 39 years of age.

"If we assume that the mortality reduction from mammography is 15 percent to 25 percent or less for young women, these results suggest that there would be no net benefit from annual mammographic screening of BRCA mutation carriers at age 25 to 29 years; the net benefit would be zero or small at age 30 to 34 years, but there should be some net benefit at age 35 or older," the authors conclude.

Abstract
Full Text

Octogenarians and Older May Benefit from Regular Mammography

By Todd Neale
HOUSTON, 24 april 2008-- For octogenarian women and older, regular screening mammography may translate into earlier breast cancer diagnoses and better disease-specific survival.
So revealed a retrospective database study of 12,358 women 80 or older with breast cancer, Gildy Babiera, M.D., of the University of Texas M. D. Anderson Cancer Center here, and colleagues, reported online in the Journal of Clinical Oncology. The study will be published in the May 20 print issue.
Each mammogram received within five years prior to diagnosis was associated with a 37% decreased risk of having late-stage (IIb to IV) disease (OR 0.63, 95% CI 0.63 to 0.67).
Five-year breast cancer-specific survival rates were 94% for regular mammography users, 88% for irregular users, and 82% for nonusers (P<0.0001).
However, non-breast cancer-related survival was also associated with mammography use, "suggesting a bias for healthier patients to undergo mammography," they said.
Nevertheless, they concluded, "healthcare providers should consider discussing the potential benefits of screening mammography with their older patients, particularly for those without significant comorbidity."
Randomized trials on the use of screening mammography have excluded patients older than 74, even though the proportion of the population who are 80 and older is growing, the researchers said.
Current guidelines on screening for breast cancer in older patients vary in their recommendations, with some considering life expectancy, a variable that is difficult to predict, they said.
Dr. Babiera and colleagues analyzed data from the Surveillance, Epidemiology, and End Results (SEER) -- Medicare linked database on women 80 and older who were diagnosed with breast cancer from 1996 through 2002.
Forty-nine percent of the patients had not had a screening mammography during the five years before diagnosis. Twenty-two percent had three or more screenings spaced at least 11 months apart (regular users) and 29% had one or two (irregular users).
From 1996 to 2002, regular mammography use increased from 17.2% to 25.8% and nonuse declined from 53% to 45.9%.
Whites and those who had more education, were married, and had a higher income were more likely to receive regular screenings.
Nonusers had poorer baseline health than regular users, as indicated by higher scores on the Charlson comorbidity index (P<0.0001).
Nonusers also had the highest mean tumor size (5.22 cm, 95% CI 4.57 to 5.86) compared with irregular (3.4 cm, 95% CI 2.70 to 4.10) and regular (2.9 cm, 95% CI 2.15 to 3.65) users.
Regular users had a larger percentage of stage I breast cancer compared with the rest of the cohort, and irregular and nonusers had higher percentages of stage II to IV disease.
Late-stage disease was more common among blacks (OR 1.71, 95% CI 1.45 to 2.02) and those of "other" race (OR 1.07, 95% CI 1.06 to 1.52) than among whites, even after adjusting for mammography use.
A score of 1 on the Charlson comorbidity index was also associated with higher likelihood of late-stage cancer (OR 1.48, 95% CI 1.30 to 1.69).
"Our findings are consistent with those of other reports demonstrating improvements in stage presentation for older women undergoing routine mammography, although none has focused specifically on individuals ≥80 years of age," the researchers said.
They acknowledged some limitations to the study, including the difficulty in separating screening and diagnostic mammography, the inability to account for screenings paid for outside of Medicare, and the fact that the patients in the database used in the study are more likely to be urban, affluent, and non-white compared with the general population.
They also pointed out the potential role of selection bias. "Specifically, this selection bias reflects the tendency for healthier patients, who have longer life expectancies, to undergo screening mammography."
"Despite these limitations," they said, "the SEER-Medicare database provides data on a large and geographically diverse population that can answer important questions pertaining to screening in the older adult population, especially in lieu of the exclusion of older adult populations from large controlled trials."

Primary source: Journal of Clinical OncologySource reference:Badgwell B, et al "Mammography before diagnosis among women age 80 years and older with breast cancer" J Clin Oncol 2008; DOI: 10.1200/JCO.2007.12.8058.

Given Risk-Benefit Data, Women Age 70 Opt for Routine Mammography

SYDNEY, Australia, Oct. 25 -- Seventy-year-old women resoundingly endorsed yearly mammography, rejecting the minuses that were pointed out of them, found investigators here.
The women chose to continue having an annual mammogram after studying a decision booklet citing mammography pros and cons for women their age. Alexandra Barratt, M.B.B.S., Ph.D., of the University of Sydney, and colleagues, reported in the Oct. 22 issue of the Archives of Internal Medicine.
Although better informed than a control group and able to make an informed choice, 95% of the women remained positive about continued screening, they found.
But just as many women in the control group, who received only standard information, also chose to continue screening, the researchers wrote.
Screening is generally recommended for women ages 50 to 69, but for women 70 years or older, in whom harm starts to outweigh benefit, recommendations are less clear.
For example, the U.S. Preventive Services Task Force notes that a mortality benefit from screening is still likely for women older than 70, if life expectancy is not compromised by comorbid disease.
On the other hand, there are concerns about detecting and treating cancers in older women, which, without screening, would not have affected patients' health or life expectancy.
Evaluating the risk and benefits of further screening may be difficult for individual women, and there are no evaluated decision support tools to assist them, the researchers said.
The researchers assessed 734 women in a population-based, randomized controlled trial in New South Wales, Australia. The trial was conduced from August 2005 to June 2006.
Women age 70 who had regularly participated in mammography screening were eligible for the trial. Women in the intervention group (367) received the decision aid, while those in the control group (367) received standard information available from the screening program.
The decision aid, a booklet with information, charts, and worksheets provided a clear, detailed presentation of the risks, benefits, options, and the chances of the possible outcomes for each choice.
For example, according to one of the scenarios, screening 1,000 women 70 or older over the next 10 years would result in:
Two fewer women dying of breast cancer as a result of screening.
15 more women diagnosed with breast cancer, but some of these cancers would never have been found without screening.
135 women having extra tests after an abnormal mammogram, although they do not have breast cancer. However, they may worry.
824 women being correctly reassured that they do not have breast cancer.
Women who received the decision aid were better informed than the control group. The mean increase in knowledge out of a score of 10, was 2.62 for the intervention group versus 0.68 for the control group (P<0.001), the researchers reported.
Furthermore, a significantly greater percentage made what they called an informed choice (73.5% versus 48.8%; P<0.001).
The decision aid did not increase anxiety and slightly reduced decisional conflict, they said.
Women in the intervention group were less likely to be undecided about screening (odds ratio, 0.32, 95% confidence interval, 0.17-0.63, P<0.001).
Among those women who had made a decision about screening, the decision aid did not alter the odds of intending to stop screening (OR, 1.28, CI 0.63-2.61, P=0.02), the researchers reported.
Of the women randomized to the decision aid, 94.7% remained positive about continuing screening, the researchers reported. In the control group, 95.9% were also positive about screening (P=0.50).
One month after the intervention, there was no difference in the percentage of women who had participated in screening between the two groups. Actually, at this time few women had actually had a mammogram, but most indicated that they were in the process of making appointments for screening.
In an accompanying editorial, Louise C. Walter, M.D., of the VA Medical Center and the University of California San Francisco, and Carmen L. Lewis, M.D., of the University of North Carolina, wrote, "Is this high enthusiasm for screening among women in this age group appropriate?"
Currently many patients, even elderly women in poor health, do not make informed decisions about screening because they downplay the potential harm of screening.
Decision aids are a promising tool, they said, although many questions remain unanswered about how to present the information and the integration of decision aids into medical practice.
Further evaluation of strategies to best address the information needs of the diverse elderly population is needed to ensure that older adults are not left behind when it comes to maximizing informed decision making," Drs. Walter and Lewis wrote.
No financial conflicts were reported by the study authors. The study was supported by a grant from the National Health and Medical Research Council of Australia. The sponsor had no role in the design, analysis, or interpretation of the study, or the preparation, review, or approval of the manuscript.
The editorial writers reported no financial conflicts. Their work was supported by a grant from the National Health and Medical Research Council of Australia. The views expressed in this article did not necessarily reflect the position of the Department of Veterans Affairs. Primary source: Archives of Internal MedicineSource reference: Mathieu E, et al "Informed Choice in Mammography Screening: A Randomized Trial of a Decision Aid for 70-Year-Old Women" Arch Intern Med 2007; 167: 2039-2046. Additional source: Archives of Internal MedicineSource reference: Walter LC, Lewis CL, "Maximizing Informed Cancer Screening Decisions" Arch Intern Med 2007; 167: 2027-2028.