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Latest thinking on mammograms for older women

New evidence shows the tests may benefit women older than age 75.

Just as it is for younger women, routine breast cancer screening for older women is debated. The U.S. Preventive Services Task Force (USPSTF) recommends against routine mammograms for women 75 and older at average risk of breast cancer. But the American Cancer Society and other health agencies recommend that screenings continue annually as long as women are in good health. “That’s because the best data we have for mammography is for women between the ages of 40 and 75. That doesn’t mean mammography won’t reduce the death rate from breast cancer after age 75; it’s just never been studied in randomized controlled trials,” says Dr. Phoebe Freer, a radiologist at Harvard-affiliated Massachusetts General Hospital.

Risks and benefits

Dr. Freer says there are many studies that suggest but can’t prove that mammography benefits women after age 75, such as a study published online on Aug. 5, 2014, in Radiology. “These studies show that in women between ages 75 and 85, mammography detects breast cancer at an earlier stage, when it’s easier to treat,” says Dr. Freer. Later-stage treatment is often harder for older women to tolerate.

But mammography also has risks, mainly “false alarms” called false positives. They show abnormalities in breast tissue that require further testing, including biopsies, which can be painful, stressful, and expensive. Of the abnormalities recommended for biopsy, 60% to 75% turn out to be normal, according to Dr. Freer. Mammograms miss 20% of cancers.

What you should do

Is a mammogram is right for you? That’s between you and your doctor. “Mammography is considered worthwhile if a woman has a life expectancy of five to seven years,” says Dr. Freer. “If you’re an older woman who’s active with few other health problems, you should continue to get a mammogram once a year. If you know you have a disease that will limit your life span, then talk to a doctor, because a mammogram may not be necessary.”

The USPSTF recommends mammograms every two years for women ages 50 to 74. More frequent screenings may be needed for those at higher risk of breast cancer. The American Cancer Society recommends mammograms annually starting at age 40. 

Posted by: Dr.Health

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