Is Surveillance Mammography Necessary in Older Breast Cancer Survivors?
Posted: Friday, April 16, 2021
With aging, the benefits of screening mammography tend to decrease and essentially diminish when life expectancy is short. Nancy L. Keating, MD, MPH, of Brigham and Women’s Hospital, Boston, and colleagues presented a consensus statement from a multidisciplinary expert panel and the International Society of Geriatric Oncology on the benefits, dangers, and guideline gaps regarding surveillance mammography in older breast cancer survivors. Their guidelines were published in JAMA Oncology.
Publications addressing contralateral and ipsilateral breast cancer risk among survivors and the benefits and damage associated with mammography were analyzed. The investigators accounted for treatment, age (75 and older), and cancer subtype, and in-breast cancer events were quantified for patients over 10 years from diagnosis. An iterative consensus-based approach was used to create the best practice guidelines for surveillance mammography. An expert panel and focus groups formulated recommendations based on the literature and their clinical expertise.
Of individuals with hormone receptor–positive tumors treated with hormone therapy, the rate of breast cancer events was low. Participants who did not receive systemic treatment had higher rates, but screening could not detect the substantial competing distance–occurrence risk that some expressed. Cancer risks ranged from 1% to 5% for contralateral cancers and 1% to 15% for ipsilateral cancers. Survivors aged 70 to 80 years appeared to have a 1.1% annual risk of breast cancer, compared with 0.7% to 0.9% for women with no history of breast cancer.
Overall, the literature and clinicians suggested that mammography offered “little to modest clinical benefit” for older patients, likely due to the time lag of more than 10 years required to recognize minor improvements. The most common dangers of mammography were false-positive results, overtreatment, and patient anxiety. Additionally, most clinicians suggested that life expectancy, not age, should dictate the halt of routine testing, supporting a more individualized approach to breast cancer treatment in older patients.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.