Posted: Tuesday, August 29, 2023
Citing considerable uncertainty surrounding the benefits and harms of screening for breast cancer in older women, Ilana B. Richman, MD, MHS, of Yale School of Medicine and Yale Cancer Center, and colleagues designed a study to quantify the risk of overdiagnosis of breast cancer associated with mammography in this population. Their findings, published in Annals of Internal Medicine, suggested significant rates of overdiagnosis in women 70 and older, with no statistically significant reductions in breast cancer–specific death associated with screening.
“Overdiagnosis refers to a phenomenon where we find breast cancers through screening that never would have caused symptoms. [It] can occur when cancers grow very slowly or if a person’s life expectancy is short,” said Dr. Richman in a Yale Cancer Center press release. “Finding these breast cancers can lead to worry and can result in intensive treatments, without improving length or quality of life. The findings from this study emphasize the need for a careful evaluation of the benefits and harms of screening older women.”
A total of 54,635 women 70 years and older who had been recently screened for breast cancer were included in the retrospective cohort study, drawn from fee-for-service Medicare claims linked to the SEER (Surveillance, Epidemiology, and End Results) program. Breast cancer diagnoses and breast cancer death were tracked for up to 15 years of follow-up. Among this cohort, the investigators estimated that 31% of women aged 70 to 74, 47% of women aged 75 to 84, and 54% of women 85 and older were potentially overdiagnosed.
Dr. Richman noted, “While our study focused on overdiagnosis, it is important to acknowledge that overdiagnosis is just one of many considerations when deciding whether to continue screening. A patient’s preferences and values, personal risk factors, and the overall balance of risks and benefits from screening are also important to take into account when making screening decisions.”
Disclosure: For full disclosures of the study authors, visit acpjournals.org.