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First Screening Mammography Guidelines for Older Breast Cancer Survivors Recommend Individualized Approach

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The first screening mammography guidelines for breast cancer survivors age 75 and older recommend continuing screening for people whose life expectancy is more than 10 years and stopping routine screening for people whose life expectancy is less than 5 years.

In general, the guidelines encourage people and their doctors to make an individualized decision for each person after discussing the benefits and risks of screening mammograms, as well as the person’s preferences.

The guidelines were published online on Jan. 28, 2021, by JAMA Oncology. Read the abstract of “Individualizing Surveillance Mammography for Older Patients After Treatment for Early-Stage Breast Cancer.”

The guidelines were developed by a national expert panel that included Professional Advisory Board member Eric Winer, M.D., professor of medicine at Harvard Medical School and chief of the division of breast oncology at the Dana-Farber Cancer Institute.

Why develop new guidelines for older breast cancer survivors?
Reviewing risks and benefits of screening mammograms
About the guidelines
What this means for you

Why develop new guidelines for older breast cancer survivors?

An annual screening mammogram has been the standard recommendation for anyone who has been treated for early-stage breast cancer.

“There has been little guidance on how to tailor screening for older survivors — what role life expectancy, risk of recurrence, patient preferences, or the trade-offs associated with mammography should play,” Rachel Freedman, M.D., of the Dana-Farber Cancer Institute and first author of the paper, said in a statement. “The result is that the use of mammography for older survivors has been highly inconsistent. With the number of older women who will be diagnosed with breast cancer expected to increase in the coming years, it’s important that we find ways to individualize decisions for each patient’s circumstances and preferences.”

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Reviewing risks and benefits of screening mammograms

To develop the guidelines, a panel of 18 experts reviewed research on the risk of new or recurrent breast cancer among older breast cancer survivors. The review focused on patients age 65 and older, the subtype of breast cancer, and the treatment received. The researchers found that most older breast cancer survivors had a low risk of breast cancer in either breast, especially people who had been treated with hormonal therapy for hormone-receptor-positive breast cancer.

The research review suggested that routine screening mammography offers a slight benefit to most older people. The main drawbacks of routine mammograms were false-positive results. A false-positive is when a mammogram shows an abnormal area that looks like cancer but turns out to be normal. Ultimately the news is good: no breast cancer. But the suspicious area usually requires follow-up with more than one doctor, extra tests, and extra procedures, including a possible biopsy. There are psychological, physical, and economic costs that come with a false positive.

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About the guidelines

These guidelines for breast cancer survivors age 75 and older recommend:

  1. Once life expectancy is less than 5 years, routine mammography should be stopped for all breast cancer survivors, including people who were treated for breast cancers considered to have a high risk of recurrence, such as triple-negative or HER2-positive breast cancer.
  2. Screening mammograms should continue for anyone whose life expectancy is more than 10 years.
  3. When life expectancy is 5 to 10 years, people and their doctors should consider stopping routine screening mammograms.
  4. Screening mammograms every 2 years may be preferred by some people.
  5. By age 85, given that life expectancy is less than 5 years for most people, routine mammograms should stop, unless the person is in extraordinary health or strongly prefers to continue screening.
  6. Clinical breast exams should continue, as should patient education on being aware of any breast changes.
  7. Diagnostic mammography should be used to investigate any symptoms or clinical findings.

Freedman emphasized that the new guidelines are not strict rules, but should serve as a starting point for discussions between older breast cancer survivors and their doctors.

“The purpose of the guidelines is to offer clinicians support for having these conversations with patients and to make a shared, individualized decision for each woman,” she said.

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What this means for you

If you’re age 75 or older and have been treated for early-stage breast cancer, you can use these new guidelines to start the discussion with your doctor about your breast cancer screening plan. Make sure your doctor understands your personal preferences and knows about any other health conditions you have. Together, you can make the best decisions for your unique situation.

For more information, visit the Mammograms page.

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Written by: Jamie DePolo, senior editor

Reviewed by: Brian Wojciechowski, M.D., medical adviser

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