By Will Boggs, MD
NEW YORK, (Reuters Health) -- Mammography screening for breast
cancer offers only minimal gains in life expectancy for women beyond the age of
69, a factor that should be taken into consideration when elderly women are
deciding about breast cancer screening, US researchers suggest.
"Mammography offers the greatest potential benefit for women between 50
and 69 years old. Beyond that, the benefits are pretty small," said Dr. Karla
Kerlikowske from the University of California, San Francisco, in an interview
with Reuters Health.
Kerlikowske and colleagues compared three different breast cancer
screening strategies for women over age 65: mammography every 2 years between
ages 65 and 69; mammography every 2 years from age 65 to 69, followed by
continued mammography only for women who have higher levels of bone density; and
mammography every 2 years between ages 65 and 79. Their results are published in
the December 8th issue of The Journal of the American Medical Association.
The second strategy, basing mammography decisions on the results of bone
density testing, would add an average of only 2 days of life per woman screened,
compared to mammography only through age 69, the authors report. In other words,
more than 1,000 women would have to be enrolled in this strategy to save one
death from breast cancer, at an additional cost of nearly $67,000 per year of
life saved.
Continuing biennial mammography through age 79 would save only an
additional three-tenths of a day per woman, compared to the second strategy, the
report indicates, requiring nearly 10,000 mammograms to prevent one breast
cancer death. The additional cost to save one year of life would exceed
$117,000.
"Based on these results, one could justify using mammography to screen
healthy, elderly women with the highest bone mineral density levels as a general
policy," said Kerlikowske. "Even then, though, simply using a clinical breast
exam may be more appropriate."
All things considered, the authors suggest that elderly women might
reasonably decide to forego mammography screening for breast cancer. "Women's
preferences for a small gain in life expectancy and the potential harms of
screening should play an important role when elderly women are deciding about
screening," they conclude.
