Disparities in breast cancer screening: is it ethical?

Breast cancer incidence and mortality rise dramatically as women get older. Approximately 48% of newly diagnosed breast cancers occur in women 65 and over, while nearly 57% of the breast cancer deaths occur in these same women. A number of studies have found that elderly women are at increased risk for being diagnosed with advanced-stage breast cancer; nevertheless, it appears that elderly women do not have more poor prognostic factors that are associated with early relapse or short survival than younger women. Considering the fact that the population is aging and the increased incidence and mortality of breast cancer in the elderly, it is important to determine what can be done to reduce breast cancer mortality in the older segments of the population. Breast cancer screening with clinical breast exam and mammography, by leading to earlier diagnosis and therapy, improves the prognosis for survival. Nevertheless, data from the 1992 US National Health Interview Survey revealed that about 27% of women 65 and over had never even had a single mammogram. Of those who did have a mammogram, fewer than two-thirds had it within one year prior to the survey. The data for clinical breast exam were less discouraging, but nearly 20% of these women had never had an exam. From an ethical perspective, women in their mid-70s have an average of about 12 years of life remaining, and should be given every opportunity to live out these years in good health.