The current (2016) US Preventive Services Task Force recommendations for breast cancer screening call for breast cancer screening every 2 years for women aged 50 to 74 years. Older patients often go without mammography screening unless their doctor recommends it.
Now a new study presented at the 2017 San Antonio Breast Cancer Symposium showed that breast cancer–specific survival and overall survival were superior for women aged ≥80 years who were diagnosed through a screening mammography compared with those who found a palpable mass that led to the diagnosis.
“Elderly patients are often undertreated and underdiagnosed, affecting their overall survival, and there is limited availability of clinical trials in this population. We looked at cancer registry and state data on octogenarians with breast cancer to evaluate the impact of the method of diagnosis and treatment on patient mortality,” said Peter W. Blumencranz, MD, FACS, Medical Director, Comprehensive Breast Care Center of Tampa Bay, Clearwater, FL, who presented the study results.
“We have good evidence to suggest that older patients with a life expectancy of greater than 5 years and few or no comorbidities should have mammography screening,” he added. “These data are important for primary care doctors who treat older patients.”
Screening in Later Years Remains Beneficial
The study included 495 octogenarians with breast cancer diagnosed between 2005 and 2010. The patients’ median age at diagnosis was 85 years (range, 81-102 years); 55% of the patients were diagnosed by mammography, and 41% after a palpable mass was found in the breast.
Patients who had mammography screening were diagnosed earlier and lived longer than those who were diagnosed after discovering a palpable mass. Of those who had screening mammography, 78% had stage 0 or I disease versus 40% of the palpable mass group. Approximately 21% of the mammogram group had stage II or III disease at diagnosis versus 52% of those in the palpable mass group.
Median survival among those who died from breast cancer was 43 months in the screening mammogram group versus 24 months in the palpable mass group. Among patients who died from other causes, median survival was 55 months in the screening mammogram group versus 41.5 months in the palpable mass group.
“Screened patients still did better if they died of other causes. It could be that the people who don’t get screened are sicker or don’t take care of themselves, or don’t have a support system and aren’t as proactive about their health,” Dr Blumencranz commented. “The remarkable differences in survival makes sense, given that those in the palpable mass group were diagnosed at later stages.”
“Higher-stage breast cancer means you need more treatment,” he added.
Overall, 66% of patients received chemotherapy. Among mammogram-screened patients, 33% had radiation therapy versus 22.5% in the palpable mass group; the rate of endocrine therapy use was 24.5% versus 17.3%, respectively.
Among patients who received endocrine therapy, the median survival in those who died from breast cancer was 48 months for those in the mammography screening group versus 22 months in the palpable mass group. Among the endocrine therapy recipients who died from other causes, the median survival was 62 months in the mammography screening group versus 49.5 months in the palpable mass group.
Among patients who underwent radiation therapy and died from breast cancer, the median survival was 50 months in the mammography screening group versus 28 months in the palpable mass group. Among patients who underwent radiation therapy and died from other causes, the median survival was 96 months in the mammography screening group versus 27 months in the palpable mass group.
Dr Blumencranz said that there are tools to help make screening decisions in women aged >75 years, where no guidelines are available.
“I keep a life expectancy table or chart in my office to help me decide,” he said, suggesting that primary care doctors refer to these charts and base breast cancer screening recommendations on biological age, rather than chronological age. “If a woman in her eighties has a life expectancy of 5 years or more, she should be screened.”