Never Too Old for a Mammogram?

You are never too old to get a mammogram. According to a new study presented at RSNA 2016 in Chicago, researchers from the University of California, San Francisco (UCSF) found that women between the ages of 75 and 90 continue to benefit from screening.

Lee’s group used data from the National Mammography Database, evaluating more than 5.6 million screening mammograms performed between January 2008 and December 2014. The exams were done at 150 facilities across 31 U.S. states. Lee and her colleagues looked at patient age, mammogram results, recall rates for more testing, biopsy referrals and biopsy results. The investigators also looked at the percentage of breast cancers found when a biopsy was recommended or performed. Ideally, Lee explained, screening should result in a higher cancer detection rate and a low recall rate.

Based on an analysis of nearly 7 million mammograms over a seven-year period, “the benefit continues with increasing age up until 90,” said study author Dr. Cindy Lee. She is an assistant professor in residence at the University of California, San Francisco.

The question of when to stop having mammograms has been widely debated. In 2009, the U.S. Preventive Services Task Force issued new guidelines, saying there wasn’t enough evidence to assess the balance of benefits and harms of screening mammography in women aged 75 and older.

In the analysis, which included data from 39 states from 2008 through 2014, nearly four breast cancers were found for every 1,000 patients screened. The recall rate was 10 percent.

“We are finding more cancers with increasing age,” Lee said, which makes sense because the risk rises with age. “We are doing better at catching them,” she said. And, “we have decreased the recall rate. We are calling back fewer women for additional testing, but are finding more cancers.”

The study authors concluded that “there is no clear age cut-off point” to determine when to stop screening. The study suggests the decision to screen may depend on a woman’s personal choice and health status. Older women with 10 years of life expectancy, for instance, might choose to continue screening, Lee said.

Robert Smith, vice president of screening for the American Cancer Society, said the study findings show that mammograms are still worthwhile after the age of 70.

“Breast cancer incidence and mortality increase as women age, and roughly 30 percent of breast cancer deaths each year occur in women who were diagnosed after the age of 70,” he said.

“Many of these deaths are avoidable, as Lee and colleagues demonstrate in this new report, since mammography screening performs increasingly well as women get older. While incidence is high, the disease is slower growing and density is lower, providing improved opportunity for early detection,” Smith explained.

Bottom line: Older women can benefit from continued mammography screening and no age should be defined as the cut-off for screening. As always, the choice to continue screening should be a shared decision between the patient and her physician.

About the author: Raja P. Reddy, MD is a board certified diagnostic radiologist specializing in breast imaging. He is also a contributing editor for Women’s Imaging Specialists, a leading provider of outpatient women’s imaging services in the greater Atlanta, GA area.