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Study Finds Harms In Age 70-Plus Mammography

April 10, 2014
Written by: , Filed in: Breast Imaging, Medical Ethics, Practice Management
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Regular mammography screening for women older than 69 probably leads to overdiagnosis and overtreatment without any significant benefit, according to a study in the Netherlands.

Gerrit-Jan Liefers, MD, PhD, presented the results of the research last month at the European Breast Cancer Conference in Glasgow, Scotland. Dr. Liefers is a surgical encologist and head of the geriatric oncology research group at Leiden University Medical Center in Lieden, the Netherlands. He is also senior author of the study.

Here’s his bottom-line recommendation for women 70 or older:

A prediction tool should be developed in order to estimate which women are at increased risk of breast cancer and should receive breast cancer screening, instead of screening the whole population.

Dr. Liefers was quoted in a news release from the European Cancer Organisation, which put on the conference.

The Netherlands offers mammography screening every two years for women ages 50 through 75. The upper age limit was bumped up from 70 to 75 in 1998. Dr. Liefers and his colleagues looked at records in the Netherlands Cancer Registry, focusing on the 25,414 women ages 70 through 75 who were diagnosed with breast cancer from 1995 through 2011.

“For a screening program to be effective,” Dr. Liefers said, “one would expect that the incidence of early-stage breast cancer would increase while the incidence of advanced-stage cancer would decrease, because any cancer would have been detected at an early stage.”

In 1995, before mammography was extended to women ages 70 through 75, the incidence of early-stage tumors (0, I, and II) in that age group was 260 cases per 100,000 women. In 2011, it had increased to 382 cases per 100,000. But the incidence of advanced-stage tumors (III, IV) did not significantly change, going from 59 per 100,000 women in 1995 to 53 per 100,000 in 2011.

So mammography was catching more early-stage tumors, but apparently not many of the ones likely to develop into advanced-stage tumors. “Therefore, screening could result in overtreatment and consequently in decreased quality of life and ability to function in older breast cancer patients, without lowering the incidence of advanced-stage breast cancer or deaths from the disease,” Dr. Liefers said.

Therefore, he said, “We suggest that the decision to participate in the screening program should be personalized, for instance in discussions with primary care physicians, and be based on remaining life expectancy, the patients’ ability to function in everyday life, and their preferences.”

One thing should be noted: the Netherlands screens every two years. The American Cancer Society, the American College of Radiology, and the Society of Breast Imaging all recommend annual mammograms. Would increasing the frequency of screening to every year instead of every two years have brought about a decline in advanced-stage tumors? This research doesn’t address that question.

Related CME seminar (up to 39.25 AMA PRA Category 1 credits™): Comprehensive Review of Breast Imaging

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