Surveillance mammography common among elderly women for whom it may be unnecessary
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Key takeaways:
- Women with a first nonmetastatic breast cancer and a life expectancy greater than 10 years had a 7.6% chance of a second diagnosis.
- Surveillance mammography should be reconsidered elderly women.
Many elderly women with a history of breast cancer and shorter life expectancies continue to undergo surveillance mammography, according to data scheduled for presentation at American Society of Breast Surgeons Annual Meeting.
“Ongoing surveillance mammography in these patients may lead to overdiagnosis and overtreatment of cancers that potentially would not harm patients if left untreated,” Elizabeth Berger, MD, MS, FACS, assistant professor of surgery at Yale University School of Medicine, said in a press release.
“A positive or false positive finding may unnecessarily erode patient quality-of-life and incur costs to the patient and health care system without benefit,” Berger added. “Our study is unique because it looked at surveillance patterns among older women grouped not by age but by estimated remaining life expectancy. This is an important factor in determining the ultimate benefits of this care.”
Background and methodology
Elderly women with a history of breast cancer have a higher risk for a second breast cancer diagnosis; however, questions remain regarding the appropriate mammographic surveillance methods for this patient population.
Berger and colleagues sought to characterize surveillance mammography use and risk for subsequent breast cancer diagnosis based on life expectancy among women with a history of breast cancer who received treatment at an older age.
They analyzed SEER-Medicare registry data of 44,475 women aged 67 years or older (30% aged > 80 years) who had been diagnosed with a first nonmetastatic breast cancer between 2003 and 2007. Researchers followed the women from 1 year after diagnosis until occurrence of a second primary breast cancer, death or end of follow-up period in 2017.
Receipt of surveillance mammography over time and diagnosis of a second primary breast cancer served as primary outcomes.
Results
The majority of breast cancer diagnoses occurred in the early stage, with 74% of the patient population diagnosed with stage 1 or 2 breast cancer and 72% of the cohort having hormone receptor-positive disease.
Approximately 55% of women had at least one comorbid condition, and 16% had three or more.
One year after diagnosis, 26% of patients had a life expectancy of less than 5 years, 36% of 6 to 10 years and 38% of greater than 10 years.
Among women with a life expectancy of less than 5 years, 68% received a mammogram 1 year after treatment and 53% receive three mammograms 3 years after treatment.
Researchers found women with a life expectancy of less than 5 years had a 3.7% chance (95% CI, 3.2-4.3) of developing a second primary breast cancer diagnosis, whereas women with a life expectancy of 6 to 10 years had a 4.9% chance (95% CI, 4.5-5.3) and women with a life expectancy of more than 10 years had a 7.6% chance (95% CI, 7.2-7.9).
Women with a life expectancy of less than 5 years and triple-negative breast cancer had a 4% cumulative incidence of a second primary breast cancer diagnosis, compared with 3% for women with hormone receptor-positive breast cancer.
Researchers found women with a life expectancy of more than 10 years and a triple-negative breast cancer had a 9.2% cumulative incidence of developing a second primary breast cancer diagnosis, compared with 7% for women with hormone receptor-positive breast cancer and a life expectancy of more than 10 years.
Next steps
Although a difficult topic for patients and oncologists, researchers stated that the risks and benefits of surveillance mammography should be taken into consideration when deciding potential treatment for elderly women.
“For women with significant competing mortality risks unlikely to die of a breast cancer diagnosed at an older age, mammography brings little benefit,” Berger said in the release. “Our study suggests the need for value-based and patient-centered stratification of older patients considered for mammography surveillance and development of a tool for shared decision-making between patient and physician.”
References:
- Berger E, et al. Patterns of mammographic surveillance in elderly women with breast cancer. Presented at: American Society of Breast Surgeons Annual Meeting; April 26-30, 2023; Boston.
- Does mammography benefit women treated for breast cancer at an older age? (ASBS press release). Available at: www.breastsurgeons.org/meeting/2023/releases/older_patients. Published April 27, 2023. Accessed April 27, 2023.
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Berger E, et al. Patterns of mammographic surveillance in elderly women with breast cancer. Presented at: American Society of Breast Surgeons Annual Meeting; April 26-30, 2023; Boston.
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