Mammograms still important for women over 75
The question of when women should stop getting mammograms can be perplexing, mostly because experts and professional organizations often differ on the answer.
Several years ago, studies came out that showed that mammograms after the age of 75 are, in fact, beneficial. A more recent study published in the Annals of Internal Medicine in February overturned that advice.
In the new study, researchers from the Harvard School of Public Health, RTI Health Solutions and Massachusetts General Hospital acknowledged that 57 percent of women in the United States age 75 and older still get regular mammograms. They did not perform clinical trials for this topic because many medical professionals think that it would be unethical to withhold mammograms to see if more women died of breast cancer.
For that reason, instead of a clinical trial, the researchers studied data on more than one million women ages 70 to 85 by using the claims data from federal Medicare insurance for the elderly. Women in the study had no prior breast cancer diagnosis, which puts them in the “average risk” category. All of the women in the study had a life expectancy of at least 10 years, which is noteworthy because the American Cancer Society recommends mammograms for women 75 and older who are in good health and are expected to live 10 years.
Hyannis Breast Surgeon Jill Oxley, MD, FACS agrees with the American Cancer Society.
“The study was a little bit contradictory because they are admitting that a third of all women that die from breast cancer die after age 70,” she said. “But then they are trying to hone that down into for which age groups it is still most beneficial. I still don’t think that this means we should change things.”
She follows the new guidelines that the American Society of Breast Cancer Surgeons published in May 2019. Those guidelines recommend that women of average risk of breast cancer should start screening at age 40 and stop when life expectancy is less than 10 years. The American College of Radiology has a similar recommendation.
“For someone who is at average risk, who is expected to live another 10 years and who would want to be treated, it absolutely makes sense to continue to do screening mammograms,” Dr. Oxley said. “If they are screened, their cancer is likely to be earlier staged and can be treated less aggressively. It is less expensive to treat an earlier stage breast cancer, too.”
Outpatient Treatment is Usual
Most women over the age of 70 who have a lumpectomy to remove an early cancer can be treated with an outpatient surgical procedure. They are much less likely to need either radiation or chemotherapy, so their course of treatment is more easily tolerated, she added.
“We have women in their 70s and 80s, and occasionally 90s, who go forward with treatment for breast cancer,” she said “They can do quite well with surgery and a lot of the times don’t need any other treatment. Most of the time it is outpatient day surgery.”
Age is one of the biggest predicators of breast cancer and the risk continues to increase with age. When you look at radiology data in women 70 to 74, they pick up around six breast cancers per thousand mammograms, but when you go from age 75 to 89, the risk goes up to seven cancers per thousand, according to Dr. Oxley.
The other thing that she pointed out is that the new study doesn’t make sense when you look at data on life expectancy. A woman who is 70 is going to live an average of another 16 and a half years. A woman who is 75 is going to live about 13 years. At 80, life expectancy is 10 years and even at the age of 85 it is seven years.
“Even though the study is saying that mammography doesn’t impact mortality, that doesn’t fit with other data,” Dr. Oxley said. “Because cancer is still either the number one or number two cause of death for women by decade. When you get to women in their 40s through age 79, cancer deaths are number one. Its only when you get over 80 that heart disease is the number one cause of death.
“And that is not to mention the fact that on the Cape our age of diagnosis is about a decade later than the rest of Massachusetts, so I don’t think this study should change anything around here.”