Pam Harrison

April 23, 2015

TORONTO, Ontario — Breast cancer detection rates on screening mammography among women 75 years of age and older are well within recommended detection rates for younger women, according to a single center's experience, and the majority of cancers detected in the older age group had an invasive component.

These findings suggest that screening mammography should at least be considered in women 75 years of age and older, despite recent recommendations from the US Preventive Services Task Force (USPSTF) to do otherwise.

"The risk is that if Medicare doesn't cover these screening mammograms for women 75 years of age and older, women won't get screened, and we'll be missing a lot of breast cancers that otherwise could have been found early and treated early," Maya Hartman, MD, fellow, New York Presbyterian Weill Cornell Medical College, New York City, told Medscape Medical News during the American Roentgen Ray Society (ARRS) 2015 Annual Meeting here.

Not screening older women "could lead to much higher costs not only financially, but certainly higher morbidity and mortality costs as well," she said.

As previously reported by Medscape Medical News, screening mammography rates dropped by 6% to 17%, depending on the ethnic group involved, between 2009, when the USPSTF first recommended against screening mammography for women 75 years of age and older, and 2012.

Between 2007 and 2012, a total of 68,694 screening mammography examinations were performed at the New York Presbyterian Hospital Weill Cornell Medical College, of which 4424, or 6.4% of the total number of screens, were done in women 75 years of age and older.

Of these 4424 screens, 64 were given a Breast Imaging-Reporting and Data System (BI-RAD) score of 4 or 5, and biopsies were performed on 60 of them.

Of the 60 breasts biopsied, cancer was detected in 26 of them, yielding a cancer detection rate of 5.9 per 1000 women screened and a positive predictive value higher than 40%.

As investigators point out, this is well within the American College of Radiology's (ACR's) recommended breast cancer detection rate of between 2 and 10 per 1000 patients screened.

The vast majority of the tumors detected in the older age cohort were intermediate to high nuclear grade, Dr Hartman noted. Eight-five percent of them also had an invasive component, she added.

Almost all of the tumors detected were stage 0 or 1, suggesting that mammography detected breast cancer at the earliest possible stages in this older age cohort, which is the goal of any screening mammography program.

Furthermore, these women had no distinguishing features that might have flagged them to be high risk for breast cancer, and thus more appropriately referred for mammography.

"In the cancers we detected, only a third of the women had a family history of breast cancer, and only 50% of the women had cancers in breasts we considered either heterogeneously dense or dense category of breast tissue, so there was nothing about these women that would have separated them out or have given their doctors a reason to refer them for screening mammography," Dr Hartman said.

They also had nothing physically evident on clinical breast examination, because if they did, they would have automatically gone on to a diagnostic mammogram, she added.

"Women [aged 75 years and older] accounted for less than 10% of our total screening population, yet the breast cancer detected rate in this cohort was compatible with ACR recommendations," Dr Hartman commented.

"We believe that screening mammography should be considered for otherwise healthy women [aged 75 years and older]," she concluded.

No Surprise

Asked to comment on the study, Daniel Kopans, MD, professor of radiology, Harvard Medical School, Boston, Massachusetts, told Medscape Medical News that the study does not surprise him at all.

"The incidence of breast cancer increases with age, and there is no reason to believe that the benefits of early detection suddenly stop at age 74," Dr Kopans said in written correspondence.

"Women who have at least a 5- to 10-year life expectancy with a reasonable quality of life and who do not want to die from breast cancer should be supported if they wish to continue annual screening."

Both the ACR and the American Cancer Society recommend yearly mammography for women from the age of 40 years onward, as long as the woman is in good health.

Dr Hartman and Dr Kopans have disclosed no relevant financial relationships.

American Roentgen Ray Society (ARRS) 2015 Annual Meeting: Abstract 1130. Presented April 21, 2015.

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