By Kate Madden Yee, AuntMinnie.com staff writer
November 28, 2016

There's no evidence that women 75 and older should discontinue regular mammography screening, according to a study presented at RSNA 2016 in Chicago. In fact, researchers from the University of California, San Francisco (UCSF) found that women between the ages of 75 and 90 continue to benefit from screening.

Dr. Cindy Lee
Dr. Cindy Lee from UCSF.

"The continuing increase of cancer detection rate and positive predictive values in women between the ages of 75 and 90 does not provide evidence for age-based mammography cessation," said study lead Dr. Cindy Lee in a statement released by the RSNA.

Exactly when women should start and stop regular mammography screening has been under heated debate. Current guidelines from the U.S. Preventive Services Task Force (USPSTF) state that there isn't enough evidence of benefit to recommend screening in women 75 and older. However, the research used to set this guidance hasn't included older women, according to Lee.

"All prior randomized, controlled trials excluded women older than 75, limiting available data to small observational studies," she said.

Lee's group used data from the National Mammography Database, evaluating more than 5.6 million screening mammograms performed between January 2008 and December 2014. The exams were done at 150 facilities across 31 U.S. states. Lee and colleagues analyzed patient demographics, screening mammography results, and biopsy results; they also sorted the exams into five-year patient age increments.

The researchers calculated screening mammography performance using the following metrics: cancer detection rate, recall rate, positive predictive value for biopsy (PPV2), and biopsy performed (PPV3). They found a mean cancer detection rate of 3.74 per 1,000 patients, a recall rate of 10%, a PPV2 rate of 20%, and a PPV3 rate of 29%. In addition, all of these performance metrics gradually improved as women aged.

The findings support the argument that deciding when to stop breast cancer screening should involve each woman's personal health history and preferences, according to Lee.

"We know that the risk of breast cancer increases with age," she said. "With the uncertainty and controversy about what age to stop breast cancer screening, we want to address this gap in knowledge using a large national database."

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Copyright © 2016 AuntMinnie.com

Last Updated np 12/8/2016 2:29:11 PM

10 comments so far ...
1/26/2017 3:18:26 PM
JKeenMD
Cancer detection does not equal life saved.  Also, no  trial evidence it works.
Overdiagnosis gets worse with age.  Treatment is more toxic.
 
Otherwise agree. If you looked at the other end of the age spectrum, you will see that the performance measures are much  worse in the younger age groups.  So let's present this evidence to younger women.  Look forward to your presentation at RSNA.

1/26/2017 5:10:44 PM
MRIguy
U need help

1/26/2017 6:03:05 PM
fw
Quote from John Keen, MD

Cancer detection does not equal life saved.  Also, no  trial evidence it works.

 
The same can be said for most medical interventions once you hit 75. As people just tend to die starting at that point, proving a survival benefit acting on all-cause mortality is going to be difficult.
 
Quote from

Overdiagnosis gets worse with age.

 
I dont believe that this statement is supported by the numbers. With the increasing incidence of cancer and often decreasing breast density, the sensitivity in older women is quite good.
 
Quote from

Treatment is more toxic.

 
Doesn't have to be. With advancing age, the patient can be offered alternatives to the full-up bombardment indicated in a younger person. We know that most DCIS doesn't turn invasive for a number of years. In a 80yo patient, following it is an easier decision than in a 50yo. Also, an 80yo may choose to forgo some elements of the 'stnadard' treatment and accept some increase in the risk of metastasis in return. Having a loc and lumpectomy in local is a same-day procedure with minimal recovery. Yes, technically you may not have saved a life, but it sure beats treating the tumor once it has grown into the chestwall or skin.



1/26/2017 6:55:53 PM
Voxel77
Following DCIS at age 55 doesn't work for most women. They can't sleep....They want it out..

1/26/2017 7:52:08 PM
fw
Quote from Voxel77


Following DCIS at age 55 doesn't work for most women. They can't sleep....They want it out..

 
And if you tell someone aged 80 that there is a chance that this thing may turn into cancer when they are 90, they often sleep very well with that possibility.