A new retrospective analysis published in Current Problems in Diagnostic Radiology highlights the effectiveness of mammography screening among older women.
Previous studies have questioned the utility of such imaging, including one recently published Annals of Internal Medicine, which found that breast cancer overdiagnosis may be common across this cohort. Researchers with the University of Alabama aimed to further explore this concern, analyzing data from more than 1,400 women 60 and over who underwent breast cancer screening.
“The results suggest that mammography screening can be effective in older women, particularly as life expectancy increases,” lead author Angela Y. Chieh, with UAB’s Heersink School of Medicine, and colleagues concluded. “Although the potential harms of screening may outweigh the benefits in some cases, over half of the cancer diagnoses in this cohort were clinically relevant invasive cancers. When discussing risks and benefits of screening mammograms with elderly patients, it is recommended that clinicians take into account the potential benefits based on the findings of this study.”
Researchers gathered their information from a single tertiary care hospital in the South, pinpointing all individuals 60 and older who underwent a baseline screening mammogram between 2010 and 2022. They also unearthed information from the electronic health record, reviewing charts and images for those with Breast Imaging Reporting and Data System, or BI-RADS, 0 results, meaning findings unclear.
Across the sample, there was an estimated recall rate of 29.3% (or 413/1,409). Imaging providers detected cancer at a rate of 15 of 1,000 in baseline mammograms. Following work-up, 224 patients had a one-year follow-up and none of them were diagnosed with breast cancer. Only one of the BI-RADS 3 lesions, or 1.4%, was malignant at two years follow-up. Among those recalled, 29.6% had a family history of breast cancer. About 93.2% of recalled cases were given BI-RADS descriptors, the authors noted, with mass and focal asymmetry being the most common lesions, they wrote. About 22.1% included more than one lesion. Positive-predictive value 1 was 5.2%, PPV2 29.2%, and PPV3 31.8%.
“These findings have implications for clinical practice, underscoring the importance of informed discussions between clinicians and elderly patients regarding the risks and benefits of screening mammograms,” Chieh et al. commented. “Ultimately, this study's data contribute to the ongoing efforts to examine screening recommendations and optimize patient care in the context of breast cancer detection among older women. Improved performance is an argument for continuing recommendations for screening in this population; however concerns about overdiagnosis are not unfounded.”
Read more about the study’s results, including potential limitations, at the link below.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.