Research Confirms Many Older Women Benefit from Mammography
By Jessica Pupillo
5/21/2008
Guidelines from the U.S. Preventive Services Task Force, or USPSTF, currently do not address the issue of age when it comes to mammography, but two new studies on breast cancer screening provide evidence that women older than age 70 benefit from mammography. A third study, however, notes that annual mammograms in older populations are no more effective than triennial mammograms at preventing death from breast cancer.
The first study, "Mammography Before Diagnosis Among Women Age 80 Years and Older with Breast Cancer," in the May 20 Journal of Oncology, used Medicare data to examine mammography use in 12,358 women diagnosed with breast cancer from 1996 to 2002. Researchers compared women who received mammograms at least three times during the five-year period to women who had them less frequently or did not have a mammogram at all during that period.
Researchers found that having regular mammograms decreased the risk of being diagnosed with late-stage (i.e., stage IIb to IV) breast cancer, but only about one-fifth of women older than age 80 regularly receive mammograms. "Each mammogram obtained resulted in a 37 percent decrease in risk of late-stage cancer," said the study authors.
The study could not link regular mammography rates to better survival rates because women who receive regular mammograms also had better survival rates from other diseases, suggesting these women were in overall better health.
Research presented at the European Breast Cancer Conference in April also found that breast cancer screenings in older women are effective and reduce deaths from the disease.
The study looked at more than 860,000 women ages 70-75 in the Netherlands. Breast cancer mortality was analyzed as these women aged from 75 to 79. During this time period, researchers found a steady decline in deaths from breast cancer among women who were screened for breast cancer through age 75. By 2006, breast cancer deaths were down almost 30 percent in 75 to 79-year-olds from the average mortality rate of 166 deaths per 100,000 that occurred between 1986 and 1997.
A second study presented at the same conference, however, found that among older women, having a mammogram every three years is just as effective as having an annual mammogram. The study randomized almost 100,000 women in the United Kingdom to have either annual mammograms or to have them every three years upon turning 50. Researchers followed up with the women an average of more than 13 years later to determine breast cancer deaths.
In the population that was invited to attend annual screenings, there were 373 cancer deaths among 49,173 women. Of the 50,162 women in the control group, there were 374 breast cancer deaths. The study concluded that mortality rates in both groups showed that annual screenings did not reduce breast cancer mortality as compared to triennial screenings.
Although he doubts these studies will affect the CDC’s breast cancer screening recommendations from the USPSTF, Doug Campos-Outcalt, M.D., M.P.A., does expect future revisions of the screening guidelines to address the issue of mammography in older women. Campos-Outcalt serves as the AAFP staff liaison to the USPSTF.
"The USPSTF recommendations don't speak to (the age) issue currently, but I know they're in the process of reviewing that," Campos-Outcalt said. Any revised recommendations will take available research into consideration, he said. "A group like USPSTF spends a considerable amount of time looking at the evidence."
There are conflicting breast cancer screening recommendations among health care organizations, but the AAFP takes its lead from the USPSTF. AAFP's clinical recommendations state, "the AAFP recommends women age 40 years and older be screened for breast cancer with mammography every 1-2 years after counseling by their family physician regarding the potential risks and benefits of the procedure."
Although there is no recommended upper age limit for mammograms, as women age, physicians should use their best judgment to determine whether a mammogram would benefit the patient, Campos-Outcalt said. The age of the woman, health status and life expectancy should all be considered before ordering a mammogram, he said.
Researchers found that having regular mammograms decreased the risk of being diagnosed with late-stage (i.e., stage IIb to IV) breast cancer, but only about one-fifth of women older than age 80 regularly receive mammograms. "Each mammogram obtained resulted in a 37 percent decrease in risk of late-stage cancer," said the study authors.
The study could not link regular mammography rates to better survival rates because women who receive regular mammograms also had better survival rates from other diseases, suggesting these women were in overall better health.
Research presented at the European Breast Cancer Conference in April also found that breast cancer screenings in older women are effective and reduce deaths from the disease.
The study looked at more than 860,000 women ages 70-75 in the Netherlands. Breast cancer mortality was analyzed as these women aged from 75 to 79. During this time period, researchers found a steady decline in deaths from breast cancer among women who were screened for breast cancer through age 75. By 2006, breast cancer deaths were down almost 30 percent in 75 to 79-year-olds from the average mortality rate of 166 deaths per 100,000 that occurred between 1986 and 1997.
A second study presented at the same conference, however, found that among older women, having a mammogram every three years is just as effective as having an annual mammogram. The study randomized almost 100,000 women in the United Kingdom to have either annual mammograms or to have them every three years upon turning 50. Researchers followed up with the women an average of more than 13 years later to determine breast cancer deaths.
In the population that was invited to attend annual screenings, there were 373 cancer deaths among 49,173 women. Of the 50,162 women in the control group, there were 374 breast cancer deaths. The study concluded that mortality rates in both groups showed that annual screenings did not reduce breast cancer mortality as compared to triennial screenings.
Although he doubts these studies will affect the CDC’s breast cancer screening recommendations from the USPSTF, Doug Campos-Outcalt, M.D., M.P.A., does expect future revisions of the screening guidelines to address the issue of mammography in older women. Campos-Outcalt serves as the AAFP staff liaison to the USPSTF.
"The USPSTF recommendations don't speak to (the age) issue currently, but I know they're in the process of reviewing that," Campos-Outcalt said. Any revised recommendations will take available research into consideration, he said. "A group like USPSTF spends a considerable amount of time looking at the evidence."
There are conflicting breast cancer screening recommendations among health care organizations, but the AAFP takes its lead from the USPSTF. AAFP's clinical recommendations state, "the AAFP recommends women age 40 years and older be screened for breast cancer with mammography every 1-2 years after counseling by their family physician regarding the potential risks and benefits of the procedure."
Although there is no recommended upper age limit for mammograms, as women age, physicians should use their best judgment to determine whether a mammogram would benefit the patient, Campos-Outcalt said. The age of the woman, health status and life expectancy should all be considered before ordering a mammogram, he said.
