The current US Preventive Services Task Force guidelines call for breast cancer screening every 2 years for women between the ages of 50 and 75 years. Older patients often go without mammography screening unless their doctor recommends it. A new study of patients with breast cancer shows that breast cancer–specific survival and overall survival were superior for women in their 80s and older diagnosed by screening mammography versus those who found a palpable mass that led to diagnosis.
“Unfortunately, elderly patients are often undertreated and underdiagnosed, affecting their overall survival, and there is limited availability of clinical trials in this population. We looked at cancer registry and state data on octogenarians with breast cancer to evaluate the impact of the method of diagnosis and treatment on patient mortality. We have good evidence to suggest that older patients with a life expectancy of greater than 5 years and few or no comorbidities should have mammography screening,” said Peter W. Blumencranz, MD, Medical Director of Surgical Oncology at the BayCare Medical Group in Clearwater, FL.
“These data are important for primary care doctors who treat older patients,” he added.
The study included 495 octogenarians with breast cancer diagnosed between 2005 and 2010. Median age at diagnosis was 85 years, with a range of 81 to 102 years. Fifty-five percent were diagnosed by mammography and 45% by a palpable mass in the breast.
Mammography patients were diagnosed earlier and lived longer than those who were diagnosed because of a palpable mass. Sixty-one percent of screened patients had stage 0/I breast cancer compared with 40% of the palpable mass group. About 21% of the mammogram group had stage II/III at diagnosis versus 50% of those in the palpable mass group.
Median survival among those with breast cancer was 43 months in the screened group versus 24 months in the palpable mass group. Among patients who died of other causes, median survival was 55 months versus 41.5 months, respectively.
“Screened patients still did better if they died of other causes. It could be that the people who don’t get screened are sicker or don’t take care of themselves or don’t have a support system and aren’t as proactive about their health,” Dr Blumencranz commented. “The remarkable differences in survival make sense, given that those in the palpable mass group were diagnosed at later stages.”
“Higher-stage breast cancer means you need more treatment,” Dr Blumencranz said.
Only 6% of patients received chemotherapy. Among screened patients, 33% underwent radiation versus 22.5% of the palpable mass group. Among screened patients, 24.5% received endocrine therapy versus 17.3% of those in the palpable mass group.
Among patients who received endocrine therapy and died of breast cancer, median survival was 48 months for the mammography screening group versus 22 months for the palpable mass group. Among the endocrine therapy recipients who died of other causes, median survival was 62 months versus 49.5 months, respectively.
Among those who underwent radiation and died of breast cancer, median survival was 50 months versus 28 months, respectively. Among those who received radiation and died of other causes, median survival was 96 months versus 27 months.
Dr Blumencranz said that there are tools to help make screening decisions in women over age 75 years, for whom there are no guidelines.
“I keep a life expectancy table or chart in my office to help me decide,” he said. He suggested that primary care doctors refer to these charts and base breast cancer screening recommendations on biological age, rather than chronological age. “If a woman in her 80s has a life expectancy of 5 years or more, she should be screened."