Can a 57-year-old female long-term care resident with left hemiplegia who is unable to stand undergo a screening mammogram?

Screening Mammography for Non-Ambulatory Nursing Home Residents

Yes, this patient should receive screening mammography, as her inability to stand does not preclude the examination—modified positioning techniques allow mammography to be performed in wheelchair-bound or bed-bound patients. 1

Age-Appropriate Screening Recommendation

At 57 years old, this patient falls squarely within the age range where screening mammography provides substantial mortality benefit:

• Annual screening mammography is recommended for women aged 40-74 years, with biennial screening as an acceptable alternative. 1
• Women in this age group experience a 40% reduction in breast cancer mortality with annual screening compared to 32% with biennial screening. 1
• The ACR specifically recommends annual screening beginning at age 40 and continuing as long as the woman remains in overall good health. 1

Life Expectancy and Comorbidity Assessment

The critical question is not her mobility status but her life expectancy and overall health:

• Screening should continue if life expectancy exceeds 10 years, as it takes approximately this long for the mortality benefit to fully emerge. 1, 2, 3
• Left hemiplegia alone (likely from prior stroke) does not automatically indicate limited life expectancy unless accompanied by severe comorbidities. 1, 2
• Severe comorbidities that would suggest stopping screening include: congestive heart failure, end-stage renal disease on dialysis, oxygen-dependent COPD, moderate-to-severe dementia, or end-stage liver disease. 1, 2

If this patient has only the hemiplegia without other life-limiting conditions, she likely has sufficient life expectancy to benefit from screening. 2, 3

Technical Feasibility for Non-Ambulatory Patients

The inability to stand is not a contraindication to mammography:

• Modern mammography equipment can accommodate patients in wheelchairs through modified positioning techniques. 1
• Technologists can perform the examination with the patient seated in a wheelchair or using specialized positioning aids. 1
• The radiology facility should be contacted in advance to ensure they have experience with non-ambulatory patients and appropriate equipment access. 1

Practical Implementation Algorithm

Step 1: Assess Life Expectancy

• If severe comorbidities present (heart failure, dialysis, severe dementia, oxygen-dependent COPD): Stop screening. 1, 2
• If only mild-moderate comorbidities or hemiplegia alone: Continue screening. 2, 3

Step 2: Contact Radiology Facility

• Inform them the patient requires wheelchair-accessible mammography. 1
• Confirm they can accommodate non-ambulatory patients with modified positioning. 1

Step 3: Order Screening Mammogram

• Order annual screening mammography (or biennial as acceptable alternative). 1, 3
• Document that patient requires wheelchair access and positioning assistance. 1

Common Pitfalls to Avoid

• Do not assume physical disability equals poor life expectancy—hemiplegia alone does not preclude screening if overall health is reasonable. 2, 3
• Do not use nursing home residence as a reason to withhold screening—base the decision on actual comorbidities and functional status, not living situation. 1, 2
• Do not accept "patient can't stand" as a reason to skip mammography—this is a solvable technical issue, not a medical contraindication. 1
• Do not continue screening if life expectancy is truly less than 10 years—the harms (false positives, unnecessary biopsies, overdiagnosis) outweigh benefits in this scenario. 1, 2