Should patients stop undergoing screening mammography when they turn 75?

Women should not stop undergoing regular mammography based on their age alone, according to a new analysis published by the American Journal of Roentgenology. The authors of the article explored both the benefits and the risks of screening mammography for women ages 75 years and older.

“Older women are a vulnerable population at risk of developing and dying from breast cancer; however, screening mammography remains underutilized in these women,” wrote Bethany L. Niell, MD, of the H. Lee Moffitt Cancer Center and Research Institute in Tampa, Florida, and colleagues. They added that the benefits of older women undergoing mammography “are the same as those for younger women—early detection of smaller node-negative tumors results in less-invasive treatment, decreased morbidity, and decreased breast cancer mortality.”

Screening mammography detects invasive cancers at a higher rate in older women than younger women, the authors noted, due to breast density decreasing with age and the fact that older women are more likely to have breast cancer.

Looking at overdiagnosis in older women, the authors highlighted research that shows benefits outweigh the risks until the patient is 90 years old. They also touched on false-positive recalls and false-positive biopsies, citing statistics that show both incidents become rarer as women get older.

“On average, a false-positive recall occurs once every 11.5 years for a woman aged 50–59 years, once every 14.5 years for women aged 70–79 years, and once every 16.8 years for women older than 80 years,” they wrote. “On average, a false-positive biopsy occurs once every 164 years for a woman aged 50–59 years, once in 233 years for women 70–79 years old, and once in 500 years for women older than 80 years.”

Niell et al. noted that imaging societies have varying opinions on this issue. The American College of Radiology and Society of Breast Imaging “do not recommend stopping screening on the basis of age,” for instance, while the U.S. Preventive Services Task Force recommends biennial mammograms for women beginning at the age of 50, but those same guidelines advise such screening end at age 74.

Niell and colleagues concluded their analysis by pointing to the importance of looking at each patient’s specific situation when making such decisions. “An informed discussion of the benefits and risks of screening mammography in older women is not complete without considering each woman's individual values, overall health status, and comorbidities,” they wrote.