‘It is important to encourage the women in this group to continue annual screening.’
By Stamatia Destounis, MD
Current average life expectancy for American women is 81.30 years, with one out of every 10 women living past age 95. Though this number is expected to continue to rise, societal recommendations conflict regarding when to stop breast cancer screening. This is largely because there is little evidence evaluating the benefit of annual mammographic screening in the population of women over the age of 75.
For average risk women of screening age, mammography is the gold standard for breast cancer detection, proven to substantially reduce breast cancer mortality.
Annual screening provides the most benefit — detecting cancers when they are smaller, lower stage and grade, requiring less invasive breast cancer treatment and better prognosis.
These benefits continue for women past age 75. Increasing age is the greatest breast cancer risk factor; nearly one in five breast cancers diagnosed are in this population.
Mammography performs well in this population — recall rate is low and the positive predictive value for biopsy and cancer detection is high. Despite this, the 75-plus age group continues to be given conflicting recommendations concerning the necessity of mammography.
This led us to pursue a retrospective investigation of our patient population over a 10-year period (2007-2017), which included 763,256 screening mammography appointments; 76,885 which were performed in patients aged 75 and older. 3,944 screen-detected malignancies were found; 645 malignancies in those 75 and over.
This population made up a small percentage of our overall screening population (10 percent) yet made up 16 percent of all screen-detected cancers diagnosed.
Tumors identified were invasive (82 percent), node negative (93 percent), and low stage (71 percent), yet intermediate to high grade. Surgical intervention was pursued by 98 percent, suggesting these women intend to continue to live a long life, and these are cancers that need to be found.
The largest generation born in American history is approaching age of 75; it is important to encourage the women in this group to continue annual screening. Our findings of low stage invasive tumors support screening- providing the greatest chance of finding cancer early, requiring less invasive and taxing treatment, allowing the highest possible quality of life.