Mammogram Research to Help Older Women Make Decisions

Patient Expert

Until recently there has not been much data to help older women make decisions about mammograms.   Now a study published in September 2014 offers evidence that routine screening may be more harmful than helpful for women from 70-80.   In 1998, the Netherlands' national breast cancer screening program began routine screening of women from 69-75 which provided a large data base for researchers at Leiden University Medical Centre to study.   Researchers also looked at 13,000 women from 76-80 who were too old for the mass screening program.

During the period studied, the incidence of early stage cancers in the 69-75 years olds jumped from 248.7 cases per 100,000 women to 362.9 diagnosed cases per 100,000 women while advanced breast cancer dropped from 58.6 cases to 51.8 cases per 100,000 women.   Doctors were finding more cancers once they started looking for them.   For the older group of 75-80 year olds there were no significant changes.   The researchers concluded that mass screening of older women leads to problems with overdiagnosis.   For every advanced cancer caught, 20 early stage cancers were treated that probably wouldn't have had time to grow big enough to be deadly in the patient's life span if they had been left alone.

Why you might ask would it be a problem to find an early stage cancer in a 78 year old?    In an older person cancer treatment may actually cause more harm than a tumor too small to be felt.  One suggested guideline has been to look at life expectancy for older women when making decisions about mammograms, but there hasn't been much large scale research data to back up this idea.   The Leiden University study offers that evidence.

This kind of data puts more responsibility on each woman and her doctor to make decisions about what to do instead of relying on a one-size fits all screening program.   Breast cancer risk increases with age, so women will want to pay attention to their breasts and alert their doctors to any changes, but mammograms are designed to catch the tiny tumors that can't be felt.   In older women, these cancers probably wouldn't grow fast enough to cause a problem.

However, each woman's family history, overall health, and attitude towards treatment is unique.   Healthy women whose mothers and grandmothers lived to be 99 may feel differently about undergoing treatment for a small tumor than women who are struggling with heart disease or other serious health issues that could be made worse by cancer treatment.

So if you are in the over-70 crowd, have the talk with your doctor.   Do you still need a mammogram?   It's really up to you.

For further reading:

Breast Health for the Woman Over 70

Too Old for a Mammogram?

Do You Really Need Radiation?   Maybe Not.