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Mammography for Women Older Than 75?

Findings from this retrospective study suggest that screening mammography can lead to diagnosis of earlier-stage breast cancer in older women.

Older age is a risk factor for breast cancer. However, in published, randomized, controlled trials of mammography, researchers mainly have studied women who were younger than 70. In this retrospective study, investigators evaluated data on 12,038 women who were 69 or older when breast cancer was diagnosed; information was obtained from the Surveillance, Epidemiology, and End Results (SEER) program and Medicare claims databases.

Women who were 75 or older were more likely than younger women to be diagnosed with stage IIA or worse disease (44% vs. 36%). Older women were less likely to have undergone screening mammograms within 2 years before their diagnoses (59% vs. 67%). Among women who had undergone screening mammograms within 2 years, the prevalence of stage IIA or worse disease did not differ between younger and older women. When patients with ductal carcinoma in situ were excluded and adjustments were made for tumor grade and number of physician contacts, women who underwent mammography had smaller tumors at diagnosis than did women who did not undergo mammography; this effect was more pronounced in older women.

Comment: These results suggest that screening mammography can lead to the diagnosis of earlier-stage breast cancer in elderly woman, but they do not tell us whether the benefits of screening mammography outweigh the risks in elders. Until there is a randomized trial (which might never happen), screening mammography likely should be done in all women who do not have severe comorbid conditions; the American Geriatrics Society suggests that 4 years of life expectancy is long enough to allow accrual of benefit.

— Richard Saitz, MD, MPH

Published in Journal Watch General Medicine December 31, 2002

Citation(s):

Randolph WM et al. Regular mammography use is associated with elimination of age-related disparities in size and stage of breast cancer at diagnosis. Ann Intern Med 2002 Nov 19; 137:783-90.

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