Breast cancer in older women that is detected with mammography leads to earlier stage diagnoses and reduces the rate of more advanced breast cancer, according to a recent study published online in the journal Radiology. The researchers believe that this supports regular mammography screening in women 75 and older.

"What this study indicates is that the same benefits of early detection with mammography screening hold for women 75 years and older just as they do in younger women," Dr. Judith A. Malmgren, one of the researchers and affiliated assistant professor at the University of Washington's School of Public Health, told DOTmed News.

In recent years, controversy has surrounded mammography screening for that age group. The American Cancer Society recommends annual mammograms for women 75 and older if they are in good health but the U.S. Preventative Services Task Force states that there isn't adequate evidence concerning its benefits and harms.

The reason why there isn't sufficient evidence is because older women are not good candidates for clinical trials. "In women 75 and older, life expectancy is an issue, so to have them involved in a clinical trial, they don't have the same length of follow-up options as younger women," said Malmgren.

She decided to conduct a prospective cohort study with her research partner, Dr. Henry Kaplan, because she had access to the data she needed from the Swedish Cancer Institute in Seattle. The data from the institute's registry included over 14,000 breast cancer cases and 1,600 of them were patients over age 75.

They uncovered that a majority of the breast cancers detected with mammography were in the early stage, but the cancers detected by the physician or patient were more likely to be in the advanced stage. Additionally, the mammography-detected breast cancer patients were more often treated with lumpectomy and radiation and had fewer mastectomies and less chemotherapy than the patients with cancers detected by themselves or the physician.

They found that mammography detection leads to a 97 percent five-year disease-specific invasive cancer survival rate and the cancers detected by patients or physicians have an 87 percent rate. They concluded that mammography detection leads to a 10 percent reduction in breast cancer disease-specific mortality after five years in older women.

Malmgren said that it's important that cancer is detected in older women at an early stage because chemotherapy is usually not an option for them. "For anybody with an advanced stage of cancer at an older age, the options are really, really reduced," she said. "For women 75 and older it's actually critical to diagnose them at an earlier stage when they are totally treatable — with surgery and radiation they have a normal lifespan."

Even though the results are promising, Malmgren said that it will not influence USPSTF's standpoint because it doesn't satisfy their criteria. Her study is a prospective cohort study but the agency requires randomized clinical trials.

However, the researchers hope that the study will guide physicians and their patients toward making better informed decisions about mammography screening.

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