Breast cancer screening in older women has been a much discussed topic in the past few years. In 2009, the U.S. Preventive Services Task Force (USPSTF) recommended that mammograms shouldn’t be encouraged in women ages 75 and older because they might not benefit from the screenings. The USPSTF made this recommendation because no research had shown that these women would benefit from regular mammograms. The USPSTF also recommended that breast cancer screening should start at age 50 instead of 40 and that mammograms should be done every other year instead of every year.
Several medical organizations and advocacy groups, including the American Cancer Society and Breastcancer.org, didn’t agree with the USPSTF conclusions and ignored the recommendations. The recommendations were very controversial and were not widely adopted by doctors.
A study has found that mammography finds breast cancer at earlier stages in older women. Early-stage breast cancer is usually easier to treat than advanced-stage cancer. The study also found that because breast cancers were detected at earlier stages, the number of more advanced-stage cancer went down in older women.
The study was published online on Aug. 5, 2014 by the journal Radiology. Read the abstract of “Improved Prognosis of Women Aged 75 and Older With Mammography-detected Breast Cancer.”
Because the USPSTF recommendations caused so much controversy, the researchers wanted to see if older women actually got benefits from regular screening mammograms.
In the study, the researchers looked at the records of 1,162 women aged 75 and older who were diagnosed with breast cancer from 1990 to 2011.
During those years, breast cancers detected by mammography increased compared to breast cancers found by the women or their doctors. From 1990 to 1994:
- 49% of cancers were found by mammography
- 50% were found by women or doctors
From 2010 to 2011:
- 70% of cancers were found by mammography
- 30% were found by women or doctors
Breast cancers found by mammography were more likely to be earlier-stage cancers:
- 62% of cancers found by mammography were stage I
- 59% of cancers found by women or doctors were stage II or stage III
The researchers also found that the number of later-stage cancers went down and the number of earlier-stage cancers went up during the study years. From 1990 to 2011:
- the number of stage II cancers went down by 8%
- the number of stage III cancers went down by 8%
- the number of stage 0 cancers (DCIS) went up by 15%
Compared to women diagnosed with breast cancer that was found by them or their doctors, women diagnosed with breast cancer that was detected by mammography were more likely to be treated with lumpectomy and radiation rather than mastectomy. Women with mammography-detected breast cancer also were less likely to have chemotherapy.
Women diagnosed with breast cancer that was found by mammography were more likely to be alive 5 years after diagnosis than women with patient- or doctor-detected breast cancer:
- 97% of women with mammography-detected cancer were alive 5 years after diagnosis
- 87% of women with patient- or doctor-detected cancer were alive 5 years after diagnosis
“Longer life expectancy for women increases the importance of early detection,” said Dr. Judith Malmgren, affiliate assistant professor at the University of Washington’s School of Public Health and Community Medicine, one of the researchers who did the study. “A 75-year-old woman today has a 13-year life expectancy. You only need 5 years of life expectancy to make mammography screening worthwhile.”
Nearly all experts would agree that annual screening doesn’t make sense for an older woman who wouldn’t want to be treated for breast cancer because of personal preferences or other health issues. Still, many women age 75 and older are in reasonably good health and would want to be treated should they be diagnosed with breast cancer.
Breastcancer.org believes that the importance of diagnosing breast cancer early, when it’s most treatable, doesn’t get any less important as a woman gets older. Regular screening mammograms make sense for any woman age 75 and older who would want to be treated for breast cancer should she be diagnosed.
For more information on mammograms and other tests to detect breast cancer, visit the Breastcancer.org Breast Cancer Tests: Screening, Diagnosis, and Monitoring pages.