麻豆传媒

CHICAGO -- Enough women 75 and older undergoing mammography were found to have breast tumors in a single-center study that continued screening in this age group is justified, researchers said here.

In a study of 76,885 screening mammograms in women ages ≥75, 671 women were diagnosed with 751 malignancies that flagged for additional evaluation, according to Stamatia Destounis, MD, of the Elizabeth Wende Breast Care at the University of Rochester in New York, and colleagues.

After excluding nonbreast malignancies and patients whose electronic health records had missing data, there were 645 malignancies in 616 patients for a cancer detection rate of 8.4/1,000, they reported at the Radiological Society of North America (RSNA) annual meeting.

"There are benefits to women to screen for breast cancer yearly after age 75," Destounis said.

In 2009, the U.S. Preventive Services Task Force released controversial guidelines stating there was to assess benefits and harms of screening mammography in women ages ≥75, but others advise that women may mammography screening as long as they are in good health.

For instance, according to the , "The age to stop screening should be based on each woman's health status rather than an age-based determination." The recommends, "Screening should continue as long as a woman is in good health and is expected to live 10 more years or longer."

Destounis' group performed a retrospective records review at their center to identify patients diagnosed with cancer from 2007 to 2017.

In that time period, there were 679,168 screening appointments, with 3,480 patients diagnosed with screen-detected cancers (5.1/1,000), and 10% of the screenings were performed in women 75 and older (average age 80.3).

The authors reported that 530 of these women were diagnosed with 560 breast cancers, for a cancer detection rate of 7.8/1,000. Masses were the most common lesions (74%), and 81% of the malignancies diagnosed were invasive (5.7% grade 2 or 3).

Positive lymph nodes were reported at surgical excision in 7% of patients. Tumor stage was largely stage 0 or 1 (64%) while 12% were stage II or III.

Nearly all (98%) of the cancers were surgically excised, while a dozen cancers were not surgically excised due to advanced patient age or overall degraded patient health. The finding suggested that "most women in this age group are in good health and do want to pursue surgical options," Destounis stated. About 12% of these women were treated with hormone therapy.

"For the relatively small percentage of our screening population that was comprised of women 75 and older, the patients diagnosed in this population made up 16% of all patients diagnosed with screening-detected cancers," the authors noted.

Destounis noted that the average life expectancy for a woman in the U.S. is 81.3 years, and that one of four women who are 65 today will live into their 90s.

"We know the performance of mammography is significantly better in older women with lower recall rates and lower false positives, thus the chances of overdiagnosis is lower as well," she said. "The goal of screening is to detect breast cancers when tumors are small and node negative. The cancers in this study were largely invasive (82%), low stage (79%), and node negative (93%)."

"The benefits of screening yearly after age 75 continue to outweigh any minimal risk of additional diagnostic testing," Destounis said.

RSNA session co-moderator Catherine Giess, MD, of Brigham & Women's Hospital and Harvard Medical School in Boston, commented that the study supports the published guidelines advocating no age limit on screening mammography.

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