While many organizations, including Medicare, recommend annual mammograms for elderly women, a recent report suggests the popular breast cancer screening device might not be warranted past age 69. "There are downsides to mammograms as women get older and only a small gain in life expectancy from continuing screening," said Karla Kerlikowske, professor of medicine and epidemiology at the University of California in San Francisco. Kerlikowske led the study that appeared in the December issue of the Journal of the American Medical Association. • "As you get older, you are more likely to die of cardiovascular disease than breast cancer," she added.

The study was based on a computer model analysis tracing life expectancy of 10,000 hypothetical women under three different breast cancer screening strategies. Getting mammograms every other year for women aged 69 to 79 averted 10.8 breast cancer deaths and added, on average, only 2% days to a woman's Me. ' In the medical field, it's common for one study to seemingly contradict another study. The issue of breast cancer and the elderly is no exception.

A separate study out of the Naval Medical Center in San Diego also was released this month. While it didn't deal with screening, it challenged the long-standing notion that older women should be deprived of aggressive breast cancer treatment because they are likely to die first of something else. The study of 68 women with breast cancer who were at least 75 years old found that after three years, 24 of them had died. Among the deceased, 14 - 58 percent - died of breast cancer and not from high blood pressure, heart disease, diabetes and other problems that most of the women in the study also had. Yet, of the 68 -women who underwent lumpectomies, only 64 percent were then given radiation therapy, generally considered standard treatment. And chemotherapy was given to only 17 percent of women whose cancer had spread to lymph nodes or elsewhere in the body.

These kinds of conflicting messages can make it difficult for elderly women to decide what to do when it comes to breast cancer, a disease that is much move common in older women but is more deadly in those under the age of 50. "There's no easy answer," said Judy Perotti, director of patient services for Y-ME National Breast Cancer Organization in Chicago. "It boils down to this: Every woman has to have her own individual treatment and detection program." These days, it's not uncommon for women to live well beyond the age of 69, making the notion of annual mammograms a compelling one. But as the University of California study points out, mammograms can bring their own set of problems Kerlikowske said older women might be bothered by medical tests, office visits and waiting for results. She added that dealing with abnormal results, which often turn out to be no cause for alarm, cause unnecessary worry and anxiety. Mammograms often detect breast lesions within milk ducts which are then surgically removed despite the fact that the risk of death from them is low and they are not likely to affect mortality in elderly women. "Women's preferences for a small gain in life expectancy and the potential harms of screening should play an important role when elderly women are deciding about screening," Kerlikowske said. Y-ME's Perotti stressed that each woman should make the decision about detection and treatment herself. "If you're a severe diabetic and have heart problems and high blood pressure, probably the last thing on your list to be concerned about is breast cancer," Perotti said. "On the other hand, if you're healthy and well on your way to your 80s and 90s, you do want to be concerned about breast cancer detection."