Use of Surveillance Mammography Among Older Breast Cancer Survivors by Life Expectancy

Authors: Freedman, R.A. et. al.

Source: J Clin Oncol

doi.org/10.1200/JCO.2016.72.1209

Screening mammography for women with no history of breast cancer has been studied very closely over the years. Recommendations have evolved with the knowledge that they do not uniformly apply to all women. Regarding women with average breast cancer risk and a life expectancy of less than 10 years, the American Cancer Society recommends against continued screening mammography. However, there is wide variation in screening patterns within this population. The variation continues among older women who have had breast cancer.

While guidelines for cancer care in older adults note that screening mammograms are not expected to benefit women with life expectancies of 5 years or less, national standards recommend continued annual screening mammography for all women diagnosed with breast cancer.

The investigators attempted to understand the use of surveillance mammography in older breast cancer survivors in the US. Using responses to national questionnaires from 2000 to 2015, they evaluated over 1,600 women aged 65 or greater who were diagnosed with breast cancer. Life expectancy was calculated for each woman who reported getting screening mammograms within 12 months of the questionnaires.

Almost 80% of the women reported having screening mammograms within the year. More than 55% of them had life expectancies of five years or less, while more than 65% had life expectancies of 10 years or less. On the other hand, 14% of women with life expectancies of greater than 10 years did not report getting screening mammograms.

These results call into question the reasoning for screening mammography among older breast cancer survivors. Women with limited life expectancy should be educated about the risks and benefits of screening mammography so that they can make informed decisions. More studies and evidence-based guidelines are needed to help breast cancer providers focus on interventions that promote longevity and well-being.