Disclosures: The NIH, NCI, Susan G. Komen and American Cancer Society supported the study. Freedman reports research funding to her institution from Puma Biotechnology and Eisai outside the submitted work. Please see the literature review for all other authors’ relevant financial disclosures.
January 28, 2021
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Mammography guidelines for older breast cancer survivors emphasize individualized approach

Disclosures: The NIH, NCI, Susan G. Komen and American Cancer Society supported the study. Freedman reports research funding to her institution from Puma Biotechnology and Eisai outside the submitted work. Please see the literature review for all other authors’ relevant financial disclosures.
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An expert panel has developed the first surveillance mammography recommendations for breast cancer survivors aged 75 years and older.

The draft guidelines, published in JAMA Oncology, focus on an individualized approach to screening, taking into account the survivor’s cancer subtype, treatment received, age and health status.

Rachel A. Freedman, MD, MPH, researcher in the department of medical oncology at Dana-Farber Cancer Institute

“No guidelines exist to tackle how to use mammography in aging breast cancer survivors, and this is an issue that comes up a lot among my patients with breast cancer,” Rachel A. Freedman, MD, MPH, researcher in the department of medical oncology at Dana-Farber Cancer Institute, told Healio. “We have no consensus, patients have no education on it, and it is always hard to stop testing when people feel attached to it. My goal in this work is to bring experts together, provide clinical support for patients and their clinicians, and help navigate an individualized decision on how and when to stop routine mammograms as we age.”

Freedman and colleagues sought to develop expert consensus guidelines that facilitate tailored decision-making for routine surveillance mammography among breast cancer survivors aged 75 years or older.

An 18-member multidisciplinary expert panel — including patients, primary care physicians, radiologists and nursing experts — conducted a literature review to determine the risks for ipsilateral and contralateral breast cancer events among breast cancer survivors, as well as the harms and benefits associated with surveillance mammography in this population. Results of the literature review indicated that the majority of older breast cancer survivors have a low risk for ipsilateral and contralateral breast cancer events. Research on the harms and benefits of screening mammography suggested little to modest benefit for many older women, with drawbacks that include anxiety linked to diagnostic testing, false positives and overtreatment.

The panel developed a draft set of guidelines, which were refined and analyzed after input from clinician focus groups and critical review by the International Society for Geriatric Oncology. Recommendations include:

  • discontinuation of routine mammography for all breast cancer survivors, including those with a history of high-risk cancers, when life expectancy is less than 5 years;
  • consideration to discontinue mammography when life expectancy is between 5 years and 10 years;
  • continuation of mammography when life expectancy is more than 10 years; and
  • encouragement of individualized, shared decision-making to optimally tailor recommendations after considering the harms and benefits associated with surveillance mammography and patient preferences.

Experts also recommended ongoing clinical breast examinations and diagnostic mammography to assess clinical findings and symptoms.

“We anticipate that our expert guidelines will enhance our care of older breast cancer survivors by providing a framework for individualized discussions that focus on the benefits and harms of testing and one’s personal preferences,” Freedman said.

For more information:

Rachel A. Freedman, MD, MPH, can be reached at Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215; email: rafreedman@partners.org.