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February 2024 | George M. Pikler, M.D., Ph.D., FACP, Lead Oncology Advocate N1X10

Breast Cancer Screening in Older Women

Breast cancer screening in older women with limited life expectancy may pose more harms than benefits but many of these women still receive screening mammograms. A new study from the Yale School of Medicine, was designed to estimate the risk of overdiagnosis with routine screening mammography for women in their 70s and older. Overdiagnosis may be defined as detecting a cancer, often through screening, that would not have caused symptoms in a person’s lifetime.

The concept of overdiagnosis is a tricky one. It doesn’t refer to false positives—test results that indicate that a suspicious mass is cancer when further tests show that it actually isn’t. Instead, in overdiagnosis, a screening test does find a true cancer. But it’s a cancer that will grow very slowly—or not at all—and would never cause problems during someone’s lifetime.

Treatment for such cancers would, by definition, be unnecessary. But since there is currently no way to tell which breast cancers found on screening mammograms will grow, and how fast, women who have such cancers almost always have surgery, and sometimes additional treatments. Because older or frail women are most likely to have a shorter remaining life span, the prospect of overdiagnosis has led to sometimes intense debate about whether it’s appropriate to screen these women for breast cancer.

According to the study authors, their goal was to focus on care that improves quality of life by avoiding tests that are unlikely to be beneficial. The study found that the proportion of breast cancer that may be over diagnosed among older women who are screened is considerable and increases with advancing age and with decreasing life expectancy. For women 85 years and older, 54% of breast cancer among screened women may be over diagnosed. For younger women, aged 70 to 74 years, the proportion is smaller but still considerable at up to 31%. The study concluded that continued breast cancer screening for women 70 years and older was associated with greater incidence of breast cancer, suggesting overdiagnosis may be common among older women who are diagnosed with breast cancer after screening. Whether harms of overdiagnosis are balanced by benefits and for whom remains an important question.

Ann Intern Med. 2023; 176 (9): 1172-1180
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Erica

Erica Cross, PA

PA

Erica is a board certified Physician Assistant. She obtained her Master’s degree in Physician Assistant studies from Our Lady of the Lake College in Baton Rouge, LA. She began practicing in 2011 and has worked clinically in Orthopedics and Dermatology. The majority of her career has been spent in a Dermatology practice where she assisted in Mohs surgery, treating various types of skin cancer. She also teaches in the medical simulation department at the University of South Alabama and enjoys every aspect of medical education.