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Biennial mammograms offer same benefits as annual screening among older women
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Biennial mammograms offer older women the same benefits as annual screening while significantly reducing the likelihood of false-positive results, according to findings of a prospective population-based study.
Previous studies have shown that patients with comorbidities have high mammography utilization rates. The appropriate screening frequency among older women — defined as those aged 65 years or older — remains unclear, according to background information in the study.
Dejana Braithwaite, PhD, an assistant professor of epidemiology and biostatistics at the University of California San Francisco (UCSF), and colleagues questioned whether the benefits and risks of screening are influenced by frequency and comorbidity among older women in the community practice.
The researchers collected data from four Breast Cancer Surveillance Consortium (BCSC) mammography registries that participated in data linkage with Medicare.
The national study included 2,993 older women with breast cancer and 137,949 older women without breast cancer who underwent mammography at one of the four BCSC facilities from January 1999 to December 2006.
The study included patients who were aged 66 to 89 years at study entry.
The proportion of invasive tumors associated with less favorable characteristics were similar between the two screening arms, according to study results.
“Screening every other year, as opposed to every year, does not increase the probability of late-stage breast cancer in older women,” Braithwaite said in a press release. “Moreover, the presence of other illnesses such as diabetes or heart disease made no difference in the ratio of benefit to harm.”
Among women aged 66 to 74 years, researchers found a higher rates of false-positive results (48% vs. 29%) among those who underwent annual screening compared with those who underwent screenings every 2 years, regardless of comorbidity.
“They get no added benefit from annual screening, and face almost twice the false positives and biopsy recommendations, which may cause anxiety and inconvenience,” researcher Karla Kerlikowske, MD, a professor of medicine at UCSF and a physician at the UCSF-affiliated San Francisco VA Medical Center, said in a press release.
The results suggest clinicians must consider patients’ life expectancy and co-existing illnesses when making recommendations about cancer screening in the elderly, the researchers concluded.
Disclosure: The researchers report no relevant financial disclosures.
Perspective
Back to TopAdam M. Brufsky, MD, PhD, FACP
These are interesting data, especially given the recent data from the TEAM study presented at the San Antonio Breast Cancer Symposium. The Braithwaite study suggests that women aged 66 to 89 years have the same rates of advanced cancer incidence whether they are screened or not with mammography. The false-positive rate is also the same as in younger women, suggesting that the harm of screening may be the same in this older population. The suggestion is that we think even harder about whether to continue the practice of screening women older than age 69.
Many of us already are thinking about backing off of an aggressive screening approach in this population, given the competing causes of mortality. However, backing off of screening — at least in younger women — should be accompanied by proper use of adjuvant therapy if more advanced disease is detected. The suggestion of the TEAM trial is that women who are older are not receiving adjuvant chemotherapy for indications for which younger women would receive chemotherapy and, as a result, they are relapsing at a higher rate than expected.
The data also appear to question the dogma that breast cancer in older women is more indolent. How do we use these data? In older women, there are competing causes of mortality and this should always be considered when recommending adjuvant therapy to elderly women, especially those with extensive comorbidities. Additionally, the absolute risk of relapse still remained quite small in this group (in the single digits). These interesting data likely will not change my current practice of looking at a women's biologic age, not chronologic age, when making the decision to screen as well as to treat.
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