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For Screening Mammography, Is There a "Too Old"?

Study results indicate that mammography should have no upper age limit.

Clinicians and patients alike are uncertain whether mammography has an upper age limit beyond which screening is no longer appropriate; furthermore, relevant guidelines are inconsistent. To address this issue, investigators used a database linking national cancer registry and Medicare claims information to identify more than 12,000 women who were 80 or older at breast cancer diagnosis. Women were stratified according to use of screening mammography during the 5 years preceding diagnosis of breast cancer. Regular mammography was defined as three or more mammograms during the 5 years before diagnosis, irregular use as one to two mammograms, and nonuse as no mammograms.

The prevalence of regular mammography decreased with age from 27% of women aged 80 to 84 to 17% of those aged 85 to 89 and 8% of those 90 or older. Overall, white women were twice as likely as black women to have regular mammograms. Probability of regular mammography screening was also associated with higher educational status, being married, and higher income level. Tumor size at diagnosis correlated inversely with regularity of mammograms: Mean tumor sizes were 2.9, 3.4, and 5.2 cm in women with regular use, irregular use, or nonuse of screening, respectively, and this association persisted in analysis adjusted for confounding factors. Regular mammography also correlated inversely with tumor stage, with each mammogram resulting in a 37% decrease in risk for late-stage (IIb to IV) cancer (P<0.05). Breast cancer–specific survival correlated directly and significantly with increasing frequency of mammography.

Comment: Although the benefits of screening mammography in reducing breast cancer mortality are well accepted, most trials underlying this perspective have excluded women older than 74. With the population of older women increasing, the finding that mammography screening in women 80 or older was associated with earlier disease stage at presentation is particularly timely and clinically relevant and supports annual or biennial screening in this population. The results should encourage us to recommend regular mammography for elders without major comorbidities.

— Andrew M. Kaunitz, MD

Published in Journal Watch Women's Health May 29, 2008

Citation(s):

Badgwell BD et al. Mammography before diagnosis among women age 80 years and older with breast cancer. J Clin Oncol 2008 May 20; 26:2482.

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