BENEFITS AND BURDENS OF MAMMOGRAPHY SCREENING AMONG WOMEN AGED 80 AND OLDER

Purpose:  Although the population of women aged 80+ is increasing, there is little information on the benefits and burdens of mammography screening for these women to guide their decision-making.

Methods:  To collect this information, we performed a cohort study using the online medical record at one large academic medical center and two community health centers in Boston.  We examined the charts of 2,187 women aged 80+ who received their primary care (at least 2 notes from one primary care physician) at one of these centers between 1994 and 2004 and we followed these women through death or 12/31/06.  We excluded women with a history of breast cancer. We identified all screening mammograms, diagnostic mammograms, breast ultrasounds and biopsies performed and all breast cancers diagnosed. Death and cause of death were confirmed through 2005 using the National Death Index (NDI).  Data were also collected on race/ethnicity and insurance. 

Results: Of 2,023 women aged 80+ without a history of breast cancer, 78.7% were non-Hispanic white and 64.2% had private insurance. Over half (52.5%) had at least one screening mammogram since age 80.  The mean time of chart data available for women in their 80’s before death or 12/31/06 was 5.5 years (SD 3.3). The table below presents our findings.

Conclusions:  Women aged 80+ who were screened with mammography were much more likely to undergo diagnostic testing for work-up of breast cancer, experience a benign breast biopsy, and/or receive a diagnosis of DCIS than women who were not screened.  Regardless of screening, most women aged 80+ were diagnosed with early stage disease.  Although more women aged 80+ who were not screened died of breast cancer these results were not significant and overall few women aged 80+ died of breast cancer.  These data can be used to help women aged 80+ decide whether or not to undergo mammography screening. 

	No Screening mammos since 80 (n=962)	Screening mammos since 80 (n=1,061)	p value
Follow up time	4.5 years	6.4 years	<0.0001
Total screening mammos since 80	0	2,968	<0.0001
Abnormal screening mammos	0	139	<0.0001
Diagnostic mammos	37	129	<0.0001
Breast ultrasounds	25	53	0.01
Breast biopsies	25	45	0.06
Benign breast biopsy	2	15	0.003
Atypical ductal hyperplasia	2	2	0.92
Lobular carcinoma in situ (LCIS)	0	1	0.34
Ductal carcinoma in situ (DCIS)	0	8	0.01
Invasive breast tumors:	21	19	0.53
Stage I	16	12	0.44
Stage II	4	5	(Test of
Stage III	0	1	Trend)
Stage IV	1	1
Required secondary treatment; Alive	1	0	0.53
Breast cancer deaths	3	1	0.39
Non-breast cancer deaths	467	408	<0.0001
Alive after 12/31/2006	277	463
Uncertain (awaiting NDI data for 06)	215	189