A reader wonders: “My grandma had a mastectomy for breast cancer many years ago. Could the Family Forum doctor please clarify why older women are not required to have mammograms or Pap smears?”
QUESTION:
My grandma is a very lively and healthy 80-year-old. She had a mastectomy for breast cancer many years ago.
Could the Family Forum doctor please clarify why older women are not required to have mammograms or Pap smears?
Surely problems in these areas would be just as common for them as for younger women, even more so?
ANSWER:
With many diseases certain groups of people have been identified as having a higher probability of developing them. Breast and cervical cancers are two of these.
Some groups at higher risk may receive screening at different ages or more frequently, such as those with a family history of breast cancer or abnormal smears. Women are advised to have cervical screening until age 70-74, and it is probable that in the future cervical screening will occur only every five years instead of two as at present.
The early studies regarding mammography, done in the 1970s, were in women under 70, and showed that there was a greater number of breast cancers detected in the early post-menopausal age group. Almost by popular demand rather than scientific evidence the screening age limit has recently been extended from 65 to 70 years.
Finding a cancer does not necessarily mean cure or longer life. While breast cancer does occur after age 70 and in people who have had a previous cancer removed, it is most common in the 50-65 year group.
We do not know if, when a cancer is found, older woman live longer than younger women after diagnosis, irrespective of the treatment they receive. So until we know this, the older age groups are not routinely included in the public breast-screening program. Thus, it makes good sense to have a regular breast palpation review each year.
Cervical cancer is definitely less common in older women and may also behave differently, and may be less aggressive. If women have had regular negative Pap smears under the age of 65, they have only one sixth the risk of developing cervical cancer after 65 compared with women who were not screened.
Should your grandmother wish for either procedure she can make an appointment at the nearest Breast Screening Clinic. Pap smears are free from doctors who bulk-bill and at GP Plus clinics. Others may require a gap payment.
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