The American Cancer Society recommends breast cancer screening should continue as long as a woman with average risk of the disease is in good health and is expected to live 10 more years or longer. Other organizations, including the U.S. Preventive Services Task Force, the American College of Physicians, and the American College of Obstetricians and Gynecologists, say screening isn’t recommended for women age 75 and older or that women can consult with their doctors about whether they should continue breast cancer screening.
A study suggests women age 75 and older should continue to get screening mammograms because the number of cases of breast cancer in this age group is relatively high compared to the number of women that age who have screening.
The research was presented on Nov. 25, 2018, at the Radiological Society of North America annual meeting. Read the abstract of “Screening Mammography: There is Value in Screening Women Aged 75 and Over.”
The mammogram controversy
Doctors who question the value of mammograms say that while mammograms do save lives, for each breast cancer death prevented, three to four women are overdiagnosed. Overdiagnosis means either:
- a screening mammogram finds a suspicious area that would have been eventually diagnosed as cancer by other means, without any effect on prognosis
- a screening mammogram finds a suspicious area that never would have affected a woman’s health if it hadn’t been found or treated
False-positive results from screening mammograms also have helped fuel the debate about the value of breast cancer screening. When a mammogram shows an abnormal area that looks like a cancer but turns out to be normal, it’s called a false positive. 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.
Studies on the benefits and possible harms of screening mammograms and the resulting stories in the media have fueled an ongoing debate about the value of screening.
Not much research has been done on the value of screening mammograms for women age 75 and older. This is why many organizations don’t recommend screening for women in this age group.
Screening results in women 75 and older
To do the study, researchers at the Elizabeth Wende Breast Care facility looked at results from 763,256 screening mammograms done at the facility. Breast cancer was detected by screening mammogram in 3,944 women.
There were 76,885 women (about 10%) age 75 and older included in the study. The average age of these women was 80.4 years.
Overall, 645 breast cancers were diagnosed in 616 women in this age group:
- 82% of the breast cancers were invasive
- 63% were grade 2 or grade 3
- 98% of the cancers were treated with surgery
- 7% of the cancers had spread to the lymph nodes
"For the relatively small percentage of our screening population that was comprised of women 75 and older, the patients diagnosed in this population made up 16% of all patients diagnosed with screening-detected cancers," said Stamatia V. Destounis, M.D., radiologist at Elizabeth Wende Breast Care who presented the study. "Our findings provide important data demonstrating that there is value in screening women over 75 because there is a considerable incidence of breast cancer.
"The benefits of screening yearly after age 75 continue to outweigh any minimal risk of additional diagnostic testing," she added.
Your best chance for early detection at any age
At Breastcancer.org, we believe that a woman’s best chance for early detection of breast cancer requires coordination of our current screening tools:
- high-quality mammography
- clinical breast exam
- breast self-exam
To not use all three tools is a missed opportunity for early detection.
The reality is that every woman — even if she’s age 75 or older — is at risk for breast cancer, and this risk tends to increase over time. It’s important to understand and regularly update your health information related to breast cancer risk throughout your life with your doctor.
To get the conversation started, here are some points to talk to your doctor about:
- family history of breast or other related cancers (ovarian, melanoma)
- any test results for abnormal genes linked to a high risk of breast cancer
- results of past breast biopsies, even if they were benign
- personal history of being treated with radiation to the face and/or chest before age 30
- breast density
- weight, if you’re overweight or obese
- level of physical activity
- any use of postmenopausal combined hormone replacement therapy (HRT)
- alcohol consumption, if you regularly drink more than 3 alcoholic beverages per week
- the amount of processed food and trans fats you eat
- your smoking history
- whether or not you had a full-term pregnancy or breastfed
Breastcancer.org stands by its recommendation that all women have mammograms annually starting at age 40 and continuing as long as she is in good health and would want the breast cancer to be treated. The results of this study strongly support that recommendation. We also believe that monthly breast self-exam and annual physical exams by a doctor are essential parts of an overall breast cancer screening strategy.
If you’re at high risk for breast cancer, you should talk to your doctor about starting annual mammograms at a younger age and consider other screening tools (such as MRI or ultrasound) to maximize the opportunity for early detection.
For more information on mammograms, including where to get one and the benefits and risks, visit the Breastcancer.org Mammograms page.
Editor’s Note: The abstract for this research had to be submitted more than 7 months before the study was presented. The researchers updated the data for the presentation; this is why the data that were presented are different than what is in the abstract.
Written by: Jamie DePolo, senior editor
Reviewed by: Brian Wojciechowski, M.D., medical adviser
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