‘There is value’ in mammography for older women, study shows
Women aged 75 years and older should continue to undergo screening mammography annually, as incidence of breast cancer remains high in this age group, according to study findings.
“Ongoing debate exists regarding the age to cease screening mammography,” Stamatia V. Destounis, MD, FACR, radiologist at Elizabeth Wende Breast Care Center and clinical professor at University of Rochester Imaging Sciences, said in a press release. “Our findings provide important data demonstrating that there is value in screening women older than age 75 years, because there is a considerable incidence of breast cancer.”
The U.S. Preventive Services Task Force concluded there is not enough evidence to assess the balance of benefits and harms of screening mammography for women aged 75 years or older. The task force is calling for more evidence to be able to make a recommendation for this age group.
Destounis and colleagues pooled data on 763,256 screening mammograms conducted at Elizabeth Wende Breast Care Center between 2007 and 2017. The mammograms led to diagnoses of 3,944 screening-detected breast cancers.
The researchers then assessed the number and type of cancers diagnosed among women aged 75 years and older (average age, 80.4 years). They observed 645 malignancies (82% invasive) diagnosed in 616 women. This corresponded to a cancer rate of 8.4 detections per 1,000 exams.
HemOnc Today spoke with Destounis about the study, the clinical implications of the findings, and the debate and confusion surrounding the appropriate age to stop breast cancer screening.
Question: Can you describe the study rationale?
Answer: The population of women in the United States is aging and women are living longer. Since 2009, our government-run organizations have recommended against screening mammography for women aged 75 years or older because they insist there are not enough data to support screening in this population.
Q: How did you conduct the study?
A: The retrospective study was conducted during a 10-year period and included patients from our large community outpatient practice. We had nearly 1 million patients aged 40 years and older, of whom 10% were aged 75 years and older.
Q: What did you find?
A: We discovered that patients aged 75 years or older accounted for 16.6% of all patients diagnosed with screening-detected breast cancers in our study. These breast cancers were predominantly invasive and, thus, important to diagnose and treat. By finding these small invasive cancers, women were given the opportunity for minimal treatment with outpatient lumpectomies, and most were healthy enough to go on to treatment. These women do well with early breast cancer detection and diagnosis and subsequent conservative treatment.
Q: What do the findings mean for clinical practice?
A: Women in their 70s should continue to be screened as long as they are in reasonably good health and can undergo the imaging testing that may be required to diagnose the cancer and subsequent treatment. These findings are important for clinical practice as they confirm that screening mammography works in the elderly population. We have to advise women and educate their health care professionals of this, as many adhere to USPSTF guidelines and do not offer screening mammography to their older patients.
Q: Can you provide insights into the debate regarding the appropriate age to stop breast cancer screening?
A: The randomized controlled trials that showed a benefit in screening women for breast cancer with mammography did not include women aged older than 74 years. There have been many confusing and conflicting guidelines by many organizations.
Q: What would you say to those in the clinical community who say it is inappropriate to screen women in this age group?
A: Women in this age group are important, viable members of our society. Identifying a small breast cancer that is easily treatable will allow these women to continue to live meaningful lives, take care of their families, work, nurture and support our global community. – by Jennifer Southall
Destounis SV, et al. Abstract SSA01-04. Presented at: Radiological Society of North America Annual Meeting; Nov. 25-30, 2018; Chicago.
For more information:
Stamatia V. Destounis, MD, FACR, can be reached at University of Rochester Imaging Sciences, 170 Sawgrass Drive, Rochester, NY 14620; email: firstname.lastname@example.org.
Disclosure: Destounis reports no relevant financial disclosures.