Experts recommended discontinuing routine mammograms for breast cancer survivors with less than five years left to live as part of new imaging guidelines released Thursday.
Radiologists should also consider stopping screening for those with a five- to 10-year life expectancy, while continuing the practice for those beyond that range. The recommendations are part of new recommendations, compiled by dozens of experts in several fields and published in JAMA Oncology.
First author Rachel Freedman, MD, MPH, noted that up until this week, there had been little guidance on breast imaging for seniors who previously beat cancer.
“The result is that the use of mammography for older survivors has been highly inconsistent,” Freedman, a Harvard Medical School associate professor and senior physician with the Dana-Farber Cancer Institute, said in a statement. “With the number of older women who will be diagnosed with breast cancer expected to increase in the coming years, it’s important that we find ways to individualize decisions for each patient's circumstances and preferences.”
Freedman enlisted patients to help compile the guidelines, alongside experts in radiology, nursing, primary care, geriatrics and more. Their work included a review of relevant literature on the benefits and risks of mammography among elder patients who previously had the disease. They further hashed out their findings through focus groups and other means.
Bottom line: Mammography offers modest to little benefit for older women, presenting downsides such as false positives, anxiety and overtreatment. Freedman et al. advocate for discontinuation of screening for woman 75 or older who are expected to live less than five years, even in individuals with a history of high-risk tumors. Life expectancy is calculated by using medical history, functional independence, smoking habits, recent hospitalizations and previous falls in the past year, among other factors. Women over age 85 with a life expectancy under five years should also stop screenings, unless they are “in extraordinary health,” with a strong preference for continued imaging.
Freedman stressed that the recommendations are not set in stone and allow for leeway on a case-by-case basis.
“The purpose of the guidelines is to offer clinicians support for having these conversations with patients and to make a shared, individualized decision for each woman,” she said.
Read the full report in JAMA Oncology here.