Core Concepts
Older women undergoing mammograms face a significant risk of overdiagnosis.
Abstract
The content discusses the risk of overdiagnosis in older women who continue breast cancer screening after the age of 70. The study linked Medicare claims data with SEER data to compare breast cancer incidence and death rates among women who continued screening mammography versus those who did not. Overdiagnosis was defined as the difference in cumulative breast cancer incidence between screened and unscreened women. Results showed no significant reduction in breast cancer-specific death associated with screening, with overdiagnosis being more prevalent in in situ and localized invasive breast cancer cases. Patient preferences and risk tolerance are crucial in informing screening decisions for older women.
TOPLINE:
Older women continuing breast cancer screening after 70 face overdiagnosis risk.
METHODOLOGY:
Linked Medicare claims with SEER data for 54,635 women 70+.
Defined overdiagnosis as the difference in cumulative breast cancer incidence.
Results adjusted for age, race, and ethnicity.
TAKEAWAY:
Over 80% of women aged 70-84 and over 60% of women aged 85+ continued screening.
Estimates of overdiagnosis ranged from 31% to 54% in different age groups.
IN PRACTICE:
Patient preferences crucial in informing screening decisions for older women.
SOURCE:
Study led by Ilana Richman, MD, MHS, published in Annals of Internal Medicine.
LIMITATIONS:
Definition of screening mammography may have misclassified some diagnostic mammograms.
Results not adjusted for breast density, family history, and other risk factors.
DISCLOSURES:
Work funded by the National Cancer Institute.
Stats
Over 80% of women 70-84 years old and more than 60% of women 85 years or older continued screening.
Estimates of overdiagnosis ranged from 31% of breast cancer cases among screened women in the 70-74 age group to 54% of cases in the 85 and older group.
Quotes
"The proportion of older women who continue to receive screening mammograms and may experience breast cancer overdiagnosis is 'considerable' and 'increases with advancing age and with decreasing life expectancy.'" - Authors