Screening Mammography: There Is Value in Screening Women Aged 75 Years and Older

Abstract

Objective Patient screening mammography records performed in women aged 75 years and older were reviewed to evaluate the value of screening in this population, by determining the incidence of cancer diagnosed and associated outcomes. Methods Data from patients aged 75 years and older who presented for screening mammography and underwent biopsy with resultant malignant pathology were retrospectively collected and analyzed to record patient demographics and outcomes. Results From 2007–2017, there were 763,256 screening mammography appointments in 130,232 patients, with 3716 patients diagnosed with 4412 screen-detected malignancies (5.8 per 1000 cancers). In women aged 75 years and older, 76,885 (76,885 per 130,232, 10.1%) screening mammograms were performed in 18,497patients, with 643 malignancies diagnosed in 614 women eligible for study inclusion (8.4 per 1000 cancers). Lesions frequently presented as a mass with or without calcifications (472 per 643, 73%). A majority (529 per 643, 82%) was invasive; 79% (507 per 643) stage 0 or 1, and 63% (407 per 643) grade 2 or 3. Lymph node–positive status was confirmed in 7% of patients (46 per 614). Surgical intervention was pursued by 98% of patients (599 per 614). Conclusion Screening mammograms in women aged 75 years and older comprise a small percentage of the total screening examinations; however, they represented a significant portion of all patients diagnosed with screen-detected cancers, showing a substantial cancer detection rate. Most tumors were low stage, intermediate to high grade, and invasive. The majority had treatment involving surgery, suggesting these women are in good health and want to pursue surgical intervention. Screening mammography should be performed in this age group.

Health benefits and harms of mammography screening in older women (75+ years)—a systematic review

“…Of the 27 observational studies, 18 studies followed up women after screening and/or diagnosis; [ 4 , 16 , 21 , 23 , 26 , 32 , 33 , 35 – 37 , 40 – 43 , 45 , 48 – 50 ] follow-up times in these studies ranged from 4 months to 20 years. Three studies did not include any comparison group and provided only descriptive statistics [ 22 , 24 , 27 ] and three studies compared groups by detection methods in those with breast cancer [ 32 , 33 , 36 ]. One study had multiple comparisons (by age and screening history) [ 35 ]; the remaining studies compared mammography screening outcomes in women aged 75 years and older with screening outcomes in women: of other ages (ten studies) [ 4 , 16 , 18 , 20 , 21 , 23 , 25 , 38 , 43 , 48 ]; differing screening histories (three studies) [ 44 – 46 ]; differing screening intervals (three studies) [ 37 , 40 , 41 ] or historical unscreened women (one study) [ 49 ]; women who did not screen (one study) [ 42 ] and women who stopped screening (two studies) [ 26 , 50 ].…”

Breast Cancer Screening Recommendations Inclusive of All Women at Average Risk: Update from the ACR and Society of Breast Imaging

“…Performance metrics among women ages 75 to 90 years are increasingly favorable with higher CDRs, sensitivity, and specificity and fewer falsepositives compared with younger women [34]. Destounis et al found a substantial CDR of 8.4 in 1,000 in 18,497 women aged 75 or older, with most cancers invasive but highly treatable [84]. CISNET confirms that screening women after age 74 results in benefits in terms of breast cancer deaths averted and life-years gained with no upper age limit, although both metrics steadily decline with age [85].…”

Personalising therapy for early-stage oestrogen receptor-positive breast cancer in older women

“… 29 Mammographically detected cancers in women aged 75 years or older were much more likely to be diagnosed at a lower stage in several studies: only 12% of those assessed were node-positive at diagnosis compared with 38% of those clinically detected in the series of Malmgren and colleagues, 30 and 11% of older women with screen-detected cancers had axillary metastases, as reported by Destounis and colleagues. 31 …”