Study: Some women over 70, if diagnosed with breast cancer, need to weigh if pursuing treatment is the right course
By Deborah Jeanne Sergeant
A recent study of 54,635 women ages 70-plus by Yale School of Medicine indicates that 31% of women ages 70-74 and 47% of those 75-84 were possibly “over-diagnosed” with breast cancer.
The term means that they were found to have a kind of breast cancer that is slow growing and that treatment would likely not extend their lives or improve their quality of life.
In fact, pursuing treatment such as lumpectomy, mastectomy or chemotherapy would dramatically decrease quality of life.
“There is no exact age at which women should stop getting mammograms,” said Susan Brown, registered nurse, senior director of Health Information and Publications at Susan G. Komen headquarters in Dallas. “Breast cancer risk increases with age and mammography doesn’t appear to be less effective in women 70 and older. However, there are risks of mammography in older women, including over-diagnosis and over-treatment, when a cancer that would not have caused problems if untreated is treated and the person is subjected to side effects without receiving any real benefit from the treatment.”
Many major health organizations recommend women ages 70 and older continue to get regular mammograms as long as they are in good health and could benefit from treatment if breast cancer were found.
She added that poor health may cause some women may stop routine breast cancer screening, as would the presence of other health issues that would take precedent. The organization’s stance is that women should be able to access regular screening mammograms as long as they and their providers think they should.
When to stop mammography—and when to start—relies upon many health factors.
Robert Smith, vice president of Early Cancer Detection Science for the American Cancer Society, said that women at high risk may start with annual mammograms earlier than other women, typically around age 30.
“Some women with a first-degree relative like a mother or a sister who was diagnosed at a young age have been advised to begin screening ten years before the age that relative was when she was diagnosed,” Smith said. “Women who receive regular mammograms are more likely to have breast cancer diagnosed earlier, less likely to need aggressive treatments, and more likely to be cured. However, mammograms are not infallible; they may miss some cancers, and even when issues are found in an initial screen, further testing may be needed to confirm the presence of cancer.”
Those who are 55 and older may choose to switch to every other year. But Smith said those who are 75 or older can continue annual screening as long as they remain in good health and expect to live at least another 10 years.
At Rochester-based Elizabeth Wende Breast Care, there’s not age cutoff for mammogram for patients who want them.
“At age 25, we sit down and talk about risk factors like family history, genetic mutations, and if they’re Black or other minorities or Ashkenazi Jewish and therefore higher risk,” said Nancy Wayne, marketing administrator. “We want to offer screening opportunities earlier than 40 as needed for the higher risk women who may have a genetic mutation or who’ve had breast cancer already or have had radiation to the chest wall at a young age.”
But even for women with no history of breast cancer in their family and with no issues, Wayne said that a first mammogram by 40 is recommended.
“There’s more to it than dying,” said Avice O’Connell, director of the UR Medicine Breast Imaging program. “There are people who ignore their cancers and it’s ulcerating through their skin and dripping. You also want them to stay comfortable. It depends on the age and health of the woman coming in. In England and Ireland, they don’t do mammograms after age 70. You’d have to pay for it yourself. It’s so much easier to take out a cancer the size of a bean or grape. You can take it out and monitor without radiation or chemotherapy.”
Although the medical protocol isn’t to ignore breast cancer, the approach is different.
“We may not want to go all out like they’re 35,” O’Connell said. “If someone’s educated and informed enough, they should make that decision. There’s nothing wrong with monitoring. Screening picks it up long before you feel it. If it is not growing, you could keep following it.”
Allison Magnuson, a breast cancer oncologist with URMC, looks at age as only a number—and only one aspect of the patient’s health profile.
“The number really doesn’t mean a lot,” she said. We need to step back and look at overall health status and what is their remaining life expectancy. There’s a lot of variability.”
Someone in her early 70s may have numerous comorbidities and maintenance drugs. Or she could be spry, active, eating well and in good health with no issues. That’s what Magnuson refers to as “physiological aging, not chronological aging.”
“Any type of diagnosis or treatment really has to be put into the context of someone’s overall life expectancy and health status,” she said. “A medical condition that arises for someone with a shorter lifespan, it may not bother them. An indolent, slower growing cancer may not manifest into a problem in their lifetime.”
Some older women with numerous other medical problems and a new breast cancer diagnosis may enjoy a better quality of life with medication that can help slow the growth of the cancer.
Magnuson thinks that patients should discuss their providers their overall health and life expectancy when considering mammograms and if a lump is discovered.
“If side effects outweigh the benefits, we talk about this,” Magnuson said. “Talk with your doctor about your preferences. Everyone thinks differently and makes decision differently. It’s about having that conversation with your doctor about any decision. The doctor can guide you on pros and cons, but only the patient knows what’s in their own values and what value they put on those pros and cons.”