Weighing the benefits and burdens of mammography screening among women age 80 years or older

Abstract

Purpose: To examine outcomes of mammography screening among women > or = 80 years to inform decision making.

Patients and methods: We conducted a cohort study of 2,011 women without a history of breast cancer who were age > or = 80 years between 1994 and 2004 and who received care at one academic primary care clinic or two community health centers in Boston, MA. Medical record data were abstracted on all screening and diagnostic mammograms, breast ultrasounds and biopsies performed, all breast cancers diagnosed through December 31, 2006, and on sociodemographics. Date and cause of death were confirmed using the National Death Index.

Results: The majority of patients (78.6%) were non-Hispanic white and 51.4% (n = 1,034) had been screened with mammography since age 80 years. Among women who were screened, eight were diagnosed with ductal carcinoma in situ, 16 with early stage disease (1.5%), two with late stage disease, and one died as a result of breast cancer. Many (110; 11%) experienced a false-positive screening mammogram that led to 19 benign breast biopsies, eight refused work-up, and three experienced a false-negative screening mammogram; 97 were screened within 2 years of their death from other causes. There were no significant differences in the rate, stage, recurrence rate, or deaths due to breast cancer between women who were screened and those who were not screened.

Conclusion: The majority of women > or = 80 years are screened with mammography yet few benefit. Meanwhile, 12.5% experience a burden from screening. The data from this study can be used to inform elderly women's decision making and potentially lead to more rational use of screening.

Fig 1.

Outcomes of breast cancer screening among women age 80 years or older. (*)Potential benefits of screening denoted by italics and underline. Potential burdens of screening denoted with bold letters. Potential harms of not being screened denoted by capital bold letters and italics. DCIS, ductal carcinoma in situ. (*)The patient diagnosed with DCIS had a normal screening mammogram 9 months before. One of the patients who developed breast cancer had a normal screening mammogram 10 months before. The other patient had an abnormal screening mammogram 2 years before but 6-month follow-up mammogram was normal.