Recommendations for Mammography in the Presence of Advanced Age and Coexisting Disease

To the Editor.—  The recent Council Report on mammography screening¹ makes a blanket recommendation to perform an "annual screening mammogram... in asymptomatic women 50 years of age or older." This recommendation ignores the presence of coexisting disease and extremely advanced age. Should octogenarians with atrophic and readily palpable breasts really continue to have such screening annually ad infinitum? Should patients with congestive heart failure be referred for mammography every year, despite their limited prognosis?I believe these are real questions that have not been addressed adequately by the various policy-setting organizations. These considerations may be obvious to clinicians, but they are not obvious to patients, who frequently insist that their primary physicians carry out these recommendations to the letter, notwithstanding other important clinical circumstances. Such pressure is further amplified by the legal community.Those who formulate recommendations concerning repetitive screening procedures should make more effort to address the effects of