Some answers (and more questions) in mammo debate

Since the U.S. Preventive Services Task Force released mammography recommendations in 2009 that did not include routine screening for women 75 and older, there has been much debate over the benefits of screening in older women. One of the main sticking points for those reluctant to recommend screening in this population is a lack of evidence.

This week, however, a study was released that will partially address this dearth of evidence. The research, published online August 5 in Radiology, found that for women age 75 and older, breast cancers detected by mammography were diagnosed at an earlier stage, suggesting that screening also has benefits for older women.

Authors Judith A. Malmgren, PhD, affiliate assistant professor at the University of Washington’s School of Public Health and Community Medicine in Seattle, and colleagues analyzed an institutional registry containing 1,600 cases of breast cancer in women over age 75.

Results showed that 62 percent of mammography-detected cases were early stage, while physician- and patient-detected cancer were more likely to be advanced stage. Five-year disease-specific invasive cancer survival rates were 97 percent for mammography-detected cancers and 87 percent for patient- or physician-detected invasive cancers.

While the findings do seem to support screening in women 75 and older, Malmgren and colleagues noted that this is only for women who have a life expectancy of five years or more. The study also has some unanswered questions regarding the harms of screening. Gerrit-Jan Liefers, MD, PhD, a surgical oncologist at Leiden University Medical Center in the Netherlands, noted in an interview with HealthDay that screening can lead to overtreatment and the risk of side effects. The finding that mammography-detected cancers have improved survival may also not be definitive, as patient-detected tumors could be more aggressive, according to Liefers.

So questions still remain, but the work of Malmgren et al is certainly a step toward improving the available evidence.

-Evan Godt
Editor – Health Imaging