Older breast-cancer survivors evidence puzzling patterns in surveillance mammography

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Despite known risks and unknown benefits, many older survivors of breast cancer with short life expectancy go for surveillance mammography every year. Meanwhile, relatively few with robust life expectancy don’t seem to bother. At the very least, the odd juxtaposition calls for guidelines to tailor care for both these older cancer-survivor subsets.

So suggest the authors of a study published online in the Journal of Clinical Oncology.

Rachel Freedman, MD, MPH, and colleagues at Harvard Medical School used National Health Interview Survey data from six nonconsecutive years in the 2000s to look at the use of surveillance mammography by 1,040 women aged 65 and older who self-identified as survivors of breast cancer.

More than a third of the women, 33.7 percent, were 80 or older.

Adjusting for survey year, region, age, marital status, insurance, education and access to care, the researchers found that 57 percent of women with estimated life expectancy below five years received annual mammography, while only 14 percent with life expectancy greater than 10 years reported having such surveillance.

Decreasing life expectancy did correlate with decreasing use of mammography, but 56.7 percent of women with short life expectancy and 65.9 percent of those with life expectancy of 10 or fewer years reported receiving mammography in the preceding year. 

The research builds on ongoing work in this area, including a review paper Freedman lead-authored and published in the March 2017 edition of JAMA Oncology, “Surveillance Mammography in Older Patients With Breast Cancer—Can We Ever Stop?”

“In the end, even with the absence of optimal evidence to support decisions, a unified approach is needed regarding surveillance mammography in older women,” Freedman et al. wrote in the paper. “Discussions with breast cancer survivors about mammography should take into consideration not only the risks of developing new or locally recurrent breast cancer, but the competing medical conditions that are more likely to impact survival, similar to other treatment and screening decisions.”

The risks of surveillance mammography are much the same as those for screening mammography—overdiagnosis, overtreatment, anxiety brought on by false positives and so on—and they may only be magnified in older women, not least those with shorter life expectancies.