and Medicine for Seniors
Women Age 75 and Older Should Stay with Mammography
Says New Study
There are no studies on women age 75 and older,
despite the fact that they are at the highest risk for breast cancer
5, 2014 There is new evidence that supports the argument for senior
women ages 75 and older to continue in mammography screening. The
research says mammography leads to earlier stage cancer diagnosis in
older women, which reduces the rate of more advanced, difficult-to-treat
The new study is published online in the journal
Radiology. Researchers said the findings lend support to regular
mammography screening in women ages 75 and older.
The value of mammography screening in older women
has been subject to much debate in recent years. The American Cancer
Society recommends annual mammograms for women age 75 and older as long
as they are in good health, while the U.S. Preventive Services Task
Force (USPSTF) does not recommend mammography screening in this age
group, citing insufficient evidence to evaluate benefits and harms.
lack of research is chiefly responsible for the divergent
recommendations, according to Judith A. Malmgren, Ph.D., affiliate
assistant professor at the University of Washington's School of Public
Health and Community Medicine in Seattle.
"There are no studies on women age 75 and older,
despite the fact that they are at the highest risk for breast cancer,"
Dr. Malmgren and her research partner, Henry
Kaplan, M.D., from the Swedish Cancer Institute in Seattle, recently
looked at the impact of mammography detection on older women by studying
data from an institutional registry that includes more than 14,000
breast cancer cases with 1,600 patients over age 75.
The majority of mammography-detected cases were
early stage, while physician- and patient-detected cancers were more
likely to be advanced stage disease. Mammography-detected invasive
breast cancer patients were more often treated with lumpectomy and
radiation and had fewer mastectomies and less chemotherapy than patient-
or physician-detected cases.
Mammography detection was associated with a 97
percent five-year disease-specific invasive cancer survival rate,
compared with 87 percent for patient- or physician-detected invasive
"Mammography enables detection when breast cancer
is at an early stage and is easier to treat with more tolerable
options," Dr. Malmgren said. "In this study, older women with
mammography-detected invasive cancer had a 10 percent reduction in
breast cancer disease-specific mortality after five years."
The early detection provided by mammography is
particularly important in older women, Dr. Malmgren noted, because they
cannot easily tolerate the chemotherapy that is commonly used to treat
more advanced breast cancers.
"Longer life expectancies for women also increase
the importance of early detection," Dr. Malmgren said. "A 75-year-old
woman today has a 13-year life expectancy. You only need five years of
life expectancy to make mammography screening worthwhile."
Dr. Malmgren acknowledged that the potential costs
of mammography, such as those associated with false-positive results,
are an important consideration when weighing screening benefits.
However, she said that false-positive findings are less common in older
"It's easy to detect a cancer earlier in older
women because breast density is not an issue," Dr. Malmgren said. "And
mammography is not expensive, so doing it every other year would not add
a lot of cost to healthcare."
The researchers hope that the study results help
women and their physicians make better informed decisions about
mammography, ultimately leading to lower mortality rates.
"Breast cancer survival in younger women has
improved dramatically over last 20 years, but that improvement has not
been seen in older women," Dr. Malmgren said.
The study was funded by the Kaplan Cancer Research
Fund and was conducted at the Swedish Cancer Institute.
Radiology is edited by Herbert Y. Kressel,
M.D., Harvard Medical School, Boston, Mass., and owned and published by
the Radiological Society of North America, Inc. (http://radiology.rsna.org/)
RSNA is an association of more than 53,000
radiologists, radiation oncologists, medical physicists and related
scientists, promoting excellence in patient care and health care
delivery through education, research and technologic innovation. The
Society is based in Oak Brook, Ill. (RSNA.org)
"Improved Prognosis of Women Aged 75 and Older with
Mammography-detected Breast Cancer." Collaborating with Drs. Malmgren
and Kaplan were Jay Parikh, M.D., and Mary K. Atwood, C.T.R.
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