Continued breast cancer screening after age 70 may be associated with a greater incidence of asymptomatic cancer, according to a recent study published by Richman et al in the Annals of Internal Medicine. These new findings suggested that overdiagnosis may be prevalent among older female patients.
Background
Clinical guidelines advising screening in older female patients often vary because the balance of screening benefits and harms is unclear in this patient population. Previous studies have indicated that the mortality benefit of screening may be limited to female patients younger than 75 years and that the potential harms of screening in older female patients may include frequent false-positives requiring invasive testing and procedures, complications from overtreatment, unnecessary anxiety, financial hardship, consumption of limited resources, and overdiagnosis. The investigators defined overdiagnosis as detection of a tumor, often through screening, that would not have otherwise caused symptoms within a patient’s lifetime.
Study Methods and Results
In the new retrospective cohort study, the investigators analyzed the data of 54,635 female patients aged 70 years and older who had been recently screened for breast cancer. They found that the risk of overdiagnosis increased significantly with age.
Up to 31%, 47%, and 54% of the breast cancers detected among patients aged 70 to 74 years, patients aged 74 to 84 years, and patients aged 85 years and older, respectively, were overdiagnosed. The investigators noted that they did not observe statistically significant reductions in breast cancer–specific mortality rates as a result of enhanced screening.
Conclusions
The new findings indicated that overdiagnosis and screening benefits should be explicitly considered when making screening decisions. The investigators concluded that further studies may be needed to more fully understand the impact of overdiagnosis.
Disclosure: For full disclosures of the study authors, visit acpjournals.org.
