New Study Suggests Breast Cancer Screening May Offer Limited Benefits for Older Women

Breast cancer screenings past the age of 70 may be unnecessary—and even harmful—for some women, a new study suggests.

The research, published earlier this month in the Annals of Internal Medicine, raises questions about the risks of overdiagnosis and the efficacy of blanket recommendations that apply to all women in this age group.

“A key message from our research is: There’s no one-size-fits-all solution for older women,” Ilana Richman, MD, MHS, an internal medicine specialist and assistant professor at Yale School of Medicine, and the first author of the new study, told Health.

“We don’t like to think about medical interventions being harmful,” she said, “but they have risks and benefits.”

The study highlights the importance of making an individualized plan with your doctor, Melanie Chellman, MD, a diagnostic radiologist at Cleveland Clinic, told Health.

“Individual situations vary, and what’s good for the average person may not be good for a majority of people,” she explained. “That average is a moving target.”

Below, experts explain what the current guidelines are for breast cancer screenings in women over 70, what factors should be considered before discontinuing screenings, and how too much screening can be harmful to some people.

The average age for breast cancer diagnosis is 62, according to the American Cancer Society. But breast cancer screening is available to women years after the average age of diagnosis has passed.

The research team analyzed data from 54,635 women, looking at breast cancer diagnosis among screened and unscreened women in three different age groups: 70 to 74 years; 75 to 84 years; and 85 and older.

They found that screened women in all age groups were more likely to be diagnosed with breast cancer and that the risk of overdiagnosis increased with age.

The study defined “overdiagnosis” as the detection of a cancer that would not have caused symptoms in a person’s lifetime. Richman explained that many people see the detection and treatment of all cancers as beneficial, but that isn’t always the case.

“In the case of overdiagnosis, we find a breast cancer on screening, but that cancer would not have been destined to cause symptoms. It would have remained dormant,” she said.

The detection—and potential treatment plan—can be scary.

“Women who have an abnormal mammogram have to come back for at least additional imaging. [Potentially] a biopsy and ultrasound,” Richman said. “That experience is pretty anxiety-provoking.”

Overdiagnosis can take a toll on the body as well as the mind; sometimes, cancers that would never have produced symptoms end up being treated with surgery, radiation, or chemotherapy, Richman said.

An editorial written by researchers at Johns Hopkins School of Medicine stressed the downsides of overdiagnosis, noting how it often leads to overtreatment, which can then result in an increased risk of complications for older patients.

“Overdiagnosis...is associated with some harmful downstream consequences for both the individual patient and for public health,” the researchers wrote.

The question of when to stop breast cancer screenings is a murky one, Chellman said. This is because health authorities tend to disagree on the answer.

“Different medical organizations provide different guidelines,” she said.

The confusion stems in part from a lack of research on older women, Richman said.

“Fundamentally, older women were left out of the large, randomized trials done between the 1960s and 1980s, concluding in the 1990s,” she explained. “There’s this huge gap in our understanding, and when there’s a gap, we have trouble advising [patients].”

It’s also difficult to make a recommendation that will work for all women over the age of 74 since people age differently.

“There is a wide variety of health levels,” Chellman said. “Many women are medically fragile early in life, while others are active into their eighties.”

The lack of data and differing approaches from health authorities can make it difficult for women to determine when to stop getting mammograms.

“In the end, the woman needs to make an individual choice with her doctor,” Chellman said.

Richman explained that doctors consider many different factors when helping a patient decide whether to continue screening: other medical conditions, their risk for breast cancer, insurance coverage, and whether they’re physically capable of having a mammogram.

“When you get a mammogram, you have to be able to position [yourself] a certain way,” Chellman said. “If you can’t, it’s not very helpful. The patient has to be orthopedically flexible enough to get into the machine.”

Another consideration is whether or not the patient wants to continue screenings or feels safe discontinuing them.

“Some people are fine being done with screenings; other women want the security [they offer],” Richman said. “People’s preferences matter, too.”

It’s also worth noting that some women may want to continue screenings past the age of 74, even if they wouldn’t necessarily want invasive treatments should cancer be detected.

“Screening itself is just gathering information,” Chellman said.

If cancer is detected, doctors can help their patients determine what to do with that information, which may or may not include treatment. Ultimately, the new research emphasizes the importance of communicating with your doctor to decide what’s best for you.

“We don’t like to confront life expectancy,” Richman said. “But doctors can help people make screening decisions.”