Optimal breast cancer screening strategies for older women: current perspectives

Abstract

Breast cancer is a major cause of cancer-related deaths among older women, aged 65 years or older. Screening mammography has been shown to be effective in reducing breast cancer mortality in women aged 50–74 years but not among those aged 75 years or older. Given the large heterogeneity in comorbidity status and life expectancy among older women, controversy remains over screening mammography in this population. Diminished life expectancy with aging may decrease the potential screening benefit and increase the risk of harms. In this review, we summarize the evidence on screening mammography utilization, performance, and outcomes and highlight evidence gaps. Optimizing the screening strategy will involve separating older women who will benefit from screening from those who will not benefit by using information on comorbidity status and life expectancy. This review has identified areas related to screening mammography in older women that warrant additional research, including the need to evaluate emerging screening technologies, such as tomosynthesis among older women and precision cancer screening. In the absence of randomized controlled trials, the benefits and harms of continued screening mammography in older women need to be estimated using both population-based cohort data and simulation models.

Cancer statistics for adults aged 85 years and older, 2019

“…For most individuals in this age group, the small potential benefit of extending life is likely outweighed by the possible harms from screening, which are more common with increasing age. Harms include additional invasive testing (eg, biopsies), emotional stress (eg, anxiety), overtreatment of nonaggressive tumors, and excessive financial and time burdens on older patients as well as their spouses and family members . One study found that, after a screening colonoscopy, adults aged 85 years and older were more than twice as likely to experience a serious gastrointestinal event, such as perforation or bleeding, compared with adults aged 66 to 69 years (12 vs 5 events per 1000 colonoscopies, respectively) .…”

“…Harms include additional invasive testing (eg, biopsies), emotional stress (eg, anxiety), overtreatment of nonaggressive tumors, and excessive financial and time burdens on older patients as well as their spouses and family members. [52][53][54] One study found that, after a screening colonoscopy, adults aged 85 years and older were more than twice as likely to experience a serious gastrointestinal event, such as perforation or bleeding, compared with adults aged 66 to 69 years (12 vs 5 events per 1000 colonoscopies, respectively). 55 Additional considerations for the oldest adults are higher rates of indolent tumors that would not lead to morbidity or mortality because of competing risks.…”

Risk of myeloid neoplasms after radiotherapy among older women with localized breast cancer: A population-based study

“…Breast cancer is the most frequently diagnosed malignancy among women in the United States, with 41% of patients diagnosed at age 65 years or older[ 1 ]. Adjuvant radiotherapy (RT), neoadjuvant and adjuvant chemotherapy, and/or hormonal therapy are the commonly used treatments for early stage (stages 1–3) disease in addition to surgical intervention for the primary tumor.…”

Skrining Kanker Payudara pada Wanita di Indonesia

“…Umur antara 50-74 tahun, saat yang tepat untuk melakukan skrining kanker payudara, dan dari penelitian menyebutkan bahwa umur 50-75 sangat direkomendasikan untuk menurunkan angka kematian kanker payudara. 20 Selain itu, wanita yang tinggal di perkotaan cenderung secara nyata tidak melakukan skrining kanker payudara sekitar 39% dibandingkan dengan wanita yang tinggal di pedasaan. Aktivitas dan kesibukan yang lebih komplek di perkotaan menjadikan wanita tersebut enggan untuk tidak melakukan skrining kanker payudara.…”