By Louis Kuritzky, MD
Continuing Screening Mammography in Women Aged 70-79 Years
There has been no prospective, randomized, controlled trial that proves benefit for screening mammography (SM) in women older than age 70. In fact, pooled data from women older than 70 who had undergone SM in Sweden showed no reduction in breast cancer mortality. Numerous factors affect women of this age group, which have bearing upon trial analysis: 1) older women have a shorter life expectancy, reducing screening benefits; 2) women with low bone mineral density (BMD) have a demonstrated lower incidence of breast cancer, and this favorable proclivity can be easily determined; 3) ductal carcinoma in situ (DCIS) increases with age and among screened populations, but it does not appear to affect overall mortality; 4) it appears likely that older women will place higher value on present health status than future health status, which likely affects their therapeutic decision processes.
To address such issues, Kerlikowske and colleagues used a decision analysis comparing women who continue screening after age 69 vs. those who do not based upon a lower bone mineral density obtained at age 65.
The screening of all women until age 79 years was found to save 0.3 days of life per woman, compared with a strategy of checking BMD and deferring screening for women with low BMD. Using BMD to assess breast cancer risk at age 65 prior to screening mammography is more cost effective than screening all women through age 79.
Kerlikowske K, et al. JAMA 1999;282: 2156-2163.