Older Women Benefit From Mammograms Past Age 75

Ingrid Hein

November 30, 2018

Women 75 years and older should continue to have mammograms, findings from a study looking at detection and excision rates in older women indicate.

Stamatia Destounis

Screening tests for women 75 years and older are more accurate, sensitive, and specific than for younger women, said researcher Stamatia Destounis, MD, a radiologist at Elizabeth Wende Breast Care in Rochester, New York.

What's more, 98% of patients in the study cohort who were diagnosed with breast cancer underwent surgery, she told Medscape Medical News. "We know we can catch the cancers in this age group when they are small and, often times, remove them with lumpectomy."

Currently, life expectancy for American women is 81 years, and 25% of women who are now 65 years are expected to live past 90. So, she asked, "why should we not screen them? Why shouldn't they be as healthy as they can be? Why leave a woman in pain for 15 years?"

Of the 679,168 appointments for breast cancer screening at Elizabeth Wende Breast Care from 2007 to 2016, Destounis and her colleagues identified 3480 patients diagnosed with cancer (0.5%). Patients with nonbreast malignancies, those with diagnoses made without mammography, and those with incomplete records were excluded from the study.

When the analysis was limited to the 68,218 (10%) mammograms performed in women 75 years and older, 530 patients were diagnosed with 560 breast cancers (0.78%). In this cohort, average age was 80.3 years (range, 75 to 98).

"We had anecdotal evidence that cancer in this age group was on the increase, but we wanted to look at numbers and see," Destounis explained.

In the older cohort, 74% of the lesions presented as a mass, 81% were invasive, 64% of the tumors were stage 0 or 1, and 12% were stage 2 or 3.

"We wanted to look at what happens when we recommend surgical excision for this patient population," she explained. "Are they too sick? We found they are not."

Of the 530 women older than 75 years, 98% underwent surgery, and 73% of these procedures were lumpectomies performed on an outpatient basis.

"These women were able to have surgery without a problem," even those with diabetes and other conditions, Destounis told Medscape Medical News.

These data are compelling and show that there is no reason to stop screening because of age, said Gary Whitman, MD, from the University of Texas M.D. Anderson Cancer Center in Houston.

"Screening should be decided on a case by case basis," he said. "As long as the patient is thought to be in good health, it makes sense to be screening with a mammography. A healthy 75-year-old can live a long time."

It is important to assess overall health, regardless of patient age. "If you have someone with significant medical problems, that patient could have a shorter life expectancy than somebody who is older than 75," he pointed out.

When patients undergo mammography, doctors must be willing to act if results indicate. "If you absolutely feel the patient can't tolerate a treatment of any sort, then you might not want to do it," Whitman advised.

Guidelines Remain Unchanged

Confusion about when to stop screening exists because the United States Preventive Services Task Force (USPSTF) guidelines don't include women older than 75, despite the fact that several groups — including the American Cancer Society — recommend continued screening.

At the time the USPSTF guidelines were developed, there were no study data on women older than 75. "It's time these are updated," Destounis said.

Concerns about unnecessary biopsies, too many call-backs, and false-positive findings have led to some reluctance to screen this age group, "but we didn't find any negatives to screening this group," she pointed out.

"We know our population is aging. We know they have more cancer, and we know we can catch it early with screening," she said. "It's the right thing to do."

Destounis and Whitman have disclosed no relevant financial relationships.

Radiological Society of North America (RSNA) 2018 Annual Meeting. Presented November 25, 2018.

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