1. Breast cancers detected by mammography were shown to be associated with an improved survival relative to physician- and patient-detected cancers among women 75 years of age and older.
2. Tumors detected by mammography were managed more frequently with lumpectomy and radiation and less frequently with mastectomy and chemotherapy than physician- and patient-detected tumors .
Evidence Level: 2 (Good)
Study Rundown: Breast cancer screening with mammography may lead to earlier cancer detection and thus earlier, potentially curative treatment. However, there is currently little data to support the effectiveness of breast cancer screening in women 75 years of age and older despite a high disease incidence and mortality in this population. The present study aimed to evaluate the outcomes of patients 75 years of age and older with breast cancers diagnosed by mammography and compare them to patients diagnosed by other methods. Results of the investigation suggested that those breast cancers detected by mammography tended be of an earlier stage. Conversely, cancers found by physicians and patients themselves were generally more advanced in stage. Women diagnosed by mammography were less likely to undergo mastectomy. Overall, these findings translated into increased survival for women diagnosed with mammography. The study was limited by its cohort methodology and lack of cost-effectiveness data, and further trials in this patient population are necessary before widespread implementation can be recommended.
In-Depth [prospective cohort]: Study data were obtained from an institutional registry database at a community-based cancer center. Between 1990 and 2011, the registry identified 1162 women aged 75 or older with biopsy-confirmed stage 0-IV breast cancer. Over the 21 year study period, 64% (n=744) of the cancers were diagnosed with mammography and 36% (n=418) were found by either the patient or the patient’s physician (“manual detection”). Stage I cancers were more frequently detected using mammography when compared to manual detection (62% vs. 33%). Similarly, later stage breast cancers (II-IV) were more frequent among manually-detected tumors as compared to those detected by mammography (64% vs. 20%).
Five-year breast cancer-specific survival , relapse-free survival, and overall survival were all significantly higher for mammography-detected breast cancers than for manually-detected breast cancers (97% vs. 87%, 96% vs. 87%, and 85% vs. 67%, respectively; p < 0.001 for all). Cancers detected by mammography were significantly more likely to be treated with lumpectomy, and these patients received significantly fewer mastectomies (p < 0.001). Using regression analysis, breast cancer detection by mammography was associated with a 50% decreased risk of mortality as compared to manual detection, corrected for age and treatment.
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