It might be better for some to not know they have breast cancer, as they may die from other causes before they become seriously ill.
Many aspects of routine medical care were disrupted and harmed by the Covid-19 Pandemic. This was especially true for seniors who are rightfully concerned about being exposed to the virus in a hospital setting. Although many facilities now offer “safe spaces” for in-person examinations , the delay in routine checksups can make a significant difference in the severity and even survival rates of undetected or untreated diseases.
Screening mammography is one of them, especially for women aged 75 and over. I am a member of this group, which has been receiving conflicting advice for years regarding the frequency and need for routine breast exams.
There is no doubt that breast cancer is more common in women over 50. However, early detection of the disease can lead to simpler and more effective treatment. The five-year survival rate for invasive breast cancer is 99 percent in the early stages.
Some older women may be better off not knowing that they have breast cancer. They are more likely to die from another cause than breast cancer, and this could lead to them losing their lives and health. After a routine mammogram, a woman may be told that she has breast cancer. She will need to make a decision about her treatment. This can have a serious impact on her physical and emotional well-being.
The current inability of breast cancer specialists to determine which breast cancers are worthy of any treatment is a further problem. They may be too slow-growing to pose a life-threatening threat or could even disappear by themselves. In 2008 , a Norwegian study found that there were fewer cases of invasive breast cancers in women who had been screened once every six years than in women who were screened twice yearly for six years. This suggests that some cancers detected by mammograms may have spontaneously regressed.
While breast cancer mortality and incidence rise with age, evidence suggests that older women are less likely to develop the disease and have a better prognosis. Oncotype DX is a genetic test that predicts breast cancer recurrences and the likely response to chemotherapy.
It can be difficult to make a rational decision about screening due to the conflicting statistics and inconsistent guidelines. This is especially true for women who have had their breast cancers treated in their later years. My friends aged 70 and older discovered they had breast cancer during or just before the pandemic lockdown. This left me, a 79 year old breast cancer survivor of 21 decades, uncomfortable about not having my annual exam scheduled for September.
The American Cancer Society guidelines recommend that women at average risk of developing breast carcinoma have annual mammograms. They should start at 45 years old (or 40, if they prefer), then change to every two years at 55 (or every year, if desired), and continue every year for as long as their health allows.
However, the U.S. Preventive Services Task Force recommends that routine mammograms should be stopped at 75, regardless of how long a woman lives. However, there are professional guidelines that recommend continuing exams for women who have a minimum five-year life expectancy and are in good overall health.
An analysis of 763.256 mammography screenings between 2007-2017 revealed that cancer was found in 3,944 women. Ten percent of these women were aged 75 or older. Dr. Stamatia Detounis, radiologist at Elizabeth Wende Breast Care, Rochester, N.Y. reported that the majority of cancers found in older women were invasive, and should be treated. Nearly half of the cancers could spread quickly.
Healthline was informed by Dr. Destounis that screening should be done every year after the age of 75. This population continues to have mammography to detect low-stage and node-negative invasive cancers. These women can receive less invasive treatment. Each woman’s health and not her age should determine the age at which she should stop screening.
Women are also living longer, and they spend more time in productive work and good health. Dr. Destounis stated that early detection of invasive cancers can make a big difference for patients, their families, and their communities.
However, older women need to know one thing: According to Diana Miglioretti (a biostatistician at University of California, Davis), “There is no evidence that screening older women for breast cancer reduces mortality from breast cancer.” There is evidence that the benefits of screening do not show up until 10 years later.” Miglioretti said that there is also an increased risk of being overdiagnosed, which can lead to a woman discovering a type of cancer that would have been fatal in her lifetime.
Interview with Dr. Mara A. Schonberg – internist at Beth Israel Deaconess Medical Center, Boston – Dr. Miglioretti’s worries. Overdetection is a problem in older women, and even the finding of breast cancer is not always easy. To avoid one breast cancer death in older women, it takes at least 10 years to screen 1,000 women between 50 and 74. It is likely that women over 75 will need to wait longer as breast cancer is more common in these women. It is not clear that older women need all the aggressive treatment they get.
Additionally, of 1,000 women aged 75-84 who have continued mammograms for five year, 100 will receive false alarms causing anxiety and prompting a series of tests that don’t find any cancer. Dr. Schonberg stated that three out of 1,000 older women will die from breast cancer if they continue to have mammograms. This compares with four cases in the same period for women who don’t have them. Dr. Schonberg also pointed out that breast cancer is the leading cause of death for women aged 75-84 in five years.
Dr. Schonberg and his colleagues created a decision aid to help women make a decision about whether they want to continue having regular mammograms even after 75. The tool is available in English or Spanish.
It asks you 10 questions about your age and health, including your body weight, ability to smoke and any pre-existing conditions such as diabetes. A mammogram can help women live longer if they have lower health risks.
Dr. Schonberg stated that she hopes doctors will first complete the decision aid before giving older patients mammogram prescriptions.
This column focuses on the first two columns about reducing breast cancer risk.
