As women age and reach their milestone 50th birthdays, the risk of developing breast cancer becomes greater with each passing year. Early detection – identifying cancer before symptoms such as lumps appear – is crucial for successfully treating it using simpler methods than those applied to later-stage cancers.
The guidelines established by the American Cancer Society are defined by age bracket: 40 to 44 (optional annual mammograms), 45 to 54 (recommended annual screenings), and 55 and up (screenings every two years or annually if you prefer). Women should continue breast self-exams, however, and report any changes to their doctor, who may recommend a screening outside of the routine schedule.
So, when’s the cutoff, when mammograms are no longer recommended? Age 75, a number that inferences mortality. Hearing this news may easily offend some older adults and have them question, why?
At some points in a woman’s life, mammograms are not recommended due to an unfavorable risk-benefit ratio and uncertainty with what to do with the results, explained Jesse P. Houghton, MD, FACG, senior medical director of gastroenterology at Southern Ohio Medical Center. Reaching the cutoff age means it’s time to have a discussion with your loved one’s doctor about the benefits and risks associated with mammogram screenings, based on life expectancy and how healthy or sick they are. The conversation should focus on their wishes and risks for developing breast cancer.
Why age matters
“The overall thought is that the patient over the age of 75 should reasonably be expected to live 10 years,” Houghton said. “The risks of doing a test – it’s inconvenient, costly [insurance may or may not cover it], can be painful and cause distress in older adults if it results in a false positive – are not worth it if the benefit is not there.”
Houghton is more likely to recommend a mammogram for someone aged 75 and up if they previously had breast cancer, had worrisome findings on earlier mammograms or have a family history of breast, ovarian or uterine cancer—factors that put them at increased risk for the disease.
“Some patients want to avoid every test,” Houghton said. “If you give them the go-ahead, they jump right in and say, ‘Okay, I’m done.’ Other patients are more nervous and hesitant to go without it and keep doing it.’”
Houghton is of the mindset that the patient is always right.
“If a 75- or 77-year-old patient asks if they need a mammogram, I’m less likely to recommend it if they had 20 normal mammograms over the years. But it’s not unreasonable to do it because the risk of developing breast cancer goes up the older you are.”
Every patient’s situation is different, of course, and requires careful consideration.
“If you’re an 80-year-old who is really healthy, maybe you have issues with blood pressure, but you’re not taking much medication and really active, it’s reasonable to offer a screening mammogram,” he said. “The patient who’s 70 on dialysis, had open heart surgery, is bed-bound, not active—you probably would be less likely to offer that patient a mammogram to detect breast cancer because they wouldn’t live 10 years to have the benefit of doing that mammogram. There’s not a lot of data to recommend continuing screening, as far as the risk-benefit scenario goes.”
To justify doing the test, Houghton said you want to have at least a five-to-10-year expected survival rate.
“Anyone over the age of 85 is unlikely to derive much benefit from a mammogram because most people don’t live to 90 or 95,” he said. “We don’t know when someone will die, we use algorithms to figure it out. The fewer years of life left, any screening test is not recommended. You want the benefits of getting that screening test, not any negatives of it.”
If you think of a scale – with positives on one side and negatives on the other – he said the older you get, the balance shifts more to the negatives of doing the test.
“Say you’re 85, not in the best of health and the mammogram shows something positive. Do you want to go through with the surgery, mastectomy or chemotherapy? Those patients are less likely to want the last years of their life impacted by the treatment.”
Before you request the test on behalf of the older adult in your life, he advises discussing with their doctor what they’re going to do with the results. The answer will help them decide whether or not to do it. You can also take advantage of a decision aid for women ages 75 to 84, that asks questions about a woman’s overall health and medical history, to help them decide if a screening mammogram is right for them.