A new study suggests senior women in good health should continue to get the breast cancer exams.
Guidelines surrounding mammograms for women 75 years of age and older have long been a source of debate.
Now, a new study suggests a woman’s health status, and not her age, should be the deciding factor.
The study was presented recently at the annual meeting of the Radiological Society of North America.
In it, researchers suggest women age 75 and over who are healthy should continue getting mammograms due to the comparatively higher incidence of breast cancer among this age group.
But women who aren’t healthy may not need to continue screening.
The reason is simple. Mammograms aren’t considered as essential for women whose life expectancy is shorter.
“The current breast cancer screening recommendations in the United States are unclear regarding when to stop screening. Several societies with published recommendations conflict. Because of this, we felt that it was a very important and timely topic to investigate, with the goal of providing further guidance on why screening mammography may be beneficial in this population,” Dr. Stamatia Destounis, study author and attending radiologist at Elizabeth Wende Breast Care in New York, told Healthline.
Mammography is a crucial element in the early detection of breast cancer, as it can show breast changes up to a year before a physician or a patient can feel them.
Yet, confusion reigns over whether mammograms should continue or cease at age 75.
“The U.S. Preventive Services Task Force recommends stopping at age 75 as there is limited data on the survival benefit (the reason we do any screening test is because it impacts survival) to mammography over age 75. The American Cancer Society and American Society of Breast Surgeons recommend every other year over age 75 if life expectancy is greater than 10 years. The American College of Obstetricians and Gynecologists and National Comprehensive Cancer Network recommend individualizing recommendations, and the American College of Radiology recommends mammography if life expectancy is greater than five to seven years,” Dr. Deanna Attai, assistant clinical professor at the David Geffen School of Medicine at the University of California Los Angeles, told Healthline.
“Rather than a blanket statement that everyone over age 75 should get a mammogram, many guidelines recommend that if the woman has a life expectancy of at least five years and is in good general health, then it is reasonable to continue screening mammography. For those women not at high risk, every other year is also reasonable, but individualization is important,” she said.
In undertaking her study, Destounis and her colleagues analyzed data from 763,256 mammography screenings between 2007 and 2017.
Of the patients screened, cancer was diagnosed in 3,944 patients. Ten percent of the women analyzed for the study were ages 75 and older.
In all, 645 malignancies were diagnosed across 616 patients. The rate of cancer detection was just under eight-and-a-half detections for every 1,000 exams in that age group.
“Our study found that most of the cancers detected were invasive, not DCIS, and were of a variety of nuclear grades, including grades 2 and 3, supporting that these are the cancers that we want to find and get treated,” Destounis said.
“Our message is that there are benefits of screening yearly after the age of 75. Mammography continues to detect invasive cancers in this population that are node negative and low stage, allowing these women to undergo less invasive treatment. The age to stop screening should be based on each woman’s health status and not defined by their age,” she said.
Many of the experts who spoke with Healthline agree that decisions surrounding whether a woman should continue getting mammograms after age 75 should be based on a number of individual factors.
“We should not paint the 75-plus age group with a broad brush… it consists of women in very good health who can expect to live 20 plus additional years or more, and women in very poor health who should not be undergoing screening for that reason,” Robert Smith, PhD, vice president of cancer screening at the American Cancer Society, told Healthline.
“Given how well mammography performs in this age group, and the fact that breast cancer is easily detected early and may be treated less aggressively, doctors should be attentive to the importance of continuing screening as long as a woman is in good health and can be expected to live 10 or more years,” he said.
The average life expectancy for a woman in the United States is 81 years. Approximately one in four 65-year-old women today will live past the age of 90 and one in 10 will live past the age of 95.
Dr. Onalisa Winblad is a radiologist at The University of Kansas Cancer Center. She is in favor of mammograms for healthy women over 75 with a life expectancy of at least five years.
“The likelihood of breast cancer is greater the older a woman is. Older patients tolerate chemotherapy and mastectomies worse than younger patients, so it can be very important to find breast cancer early in this population. Now, if someone is in very poor health with a life expectancy less than five years, or if they would be unable to tolerate surgery or chemo anyway, then this is the population who can discontinue screening,” Winblad told Healthline.
In Destounis’ study, 82 percent of malignancies that were diagnosed were invasive cancers.
Of those, 62 percent were grades two or three, which can spread and grow quickly.
About 98 percent of the cancers were able to be treated through surgery.
In all, 17 cancers were not able to be treated surgically due to the advanced age of the patient or poor patient health overall.
Diana Miglioretti, PhD, a professor in biostatistics at the University of California Davis and a scientific member of the UC Davis Comprehensive Cancer Center, says deciding whether to continue screening past age 74 is difficult.
“There is no evidence from randomized controlled trials on whether screening women ages 75 or older reduces breast cancer mortality. Evidence suggests the benefits of screening are not seen until 10 years later. Thus, some societies recommend screening women only if their life expectancy is 10 years or greater. However, life expectancy is difficult to judge. Overdiagnosis (diagnosis of a cancer that would never harm a woman in her lifetime) also increases with age, given women are more likely to die from other causes before the breast cancer would be otherwise detected,” Miglioretti told Healthline.
Destounis says the time to stop screening should not be determined by age, but rather an individual’s health status.
For healthy women age 75 and over, she suggests continuing with mammograms.
“As our population ages and women are living longer and longer and continue to work and be important and vital members of their family and also their global community, it is extremely important to continue to screen these women and identify small invasive tumors in the breast that can be treated with minimal surgery and follow up treatment,” she said.
Guidelines surrounding whether women should continue mammograms after age 75 differ among organizations and have been the subject of much debate.
A new study presented at the Radiological Society of North America annual meeting suggests a woman’s health status, not her age, should be the deciding factor.
The reason is simple. A mammogram isn’t as important for a woman who isn’t expected to live at least 10 more years.