Breast cancer: are mammogram screenings still necessary after age 75?
In Italy, 55,000 new cases of breast cancer are diagnosed every year. Thanks to screening schedules and women’s increased awareness, most malignant breast tumors are diagnosed in the early stages. Such early diagnosis allows for conservative surgical procedures and effective treatments, which in turn guarantee a high probability of survival. About 9 out of 10 women survive 5 years after diagnosis and 8 out of 10 are alive after 10 years, for a total of around 834,000 women currently living in Italy after a breast cancer diagnosis.
Many of these patients are elderly persons and they continue regular check-ups in order to quickly detect disease recurrence, even long after the initial surgery.
Mammography is a radiographic technique that has proven to be indispensable in detecting disease relapse. Thanks to the technological advancement of recent years, exposure to ionizing radiation has been notably reduced during this procedure. Nonetheless, this exam is often the cause of stress for patients, especially the elderly, due to the psychological distress and organizational challenges that it can cause. Furthermore, the COVID-19 epidemic has only further aggravated the logistical difficulties and patient’s fear of going to the hospital.
A team of international experts from the International Society of Geriatric Oncology recently released guidelines aimed at optimizing the screening strategy for elderly patients (75 and older) with a history of localized breast cancer. The experts recommend discontinuing routine mammograms in all breast cancer survivors when life expectancy is less than 5 years and recommend considering its discontinuation when the patient’s life expectancy is 5 to 10 years. On the other hand, the team recommends continuing regular mammogram screenings for patients when life expectancy exceeds 10 years.
In any case, the experts encourage discussing the screening plan with the patient, in order to carefully assess the associated risks/benefits, by means of an individualized and shared decision-making process.
