Originally published as JCO Early Release 10.1200/JCO.2008.19.9877 on March 2 2009

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Weighing the Benefits and Burdens of Mammography Screening Among Women Age 80 Years or Older

From the Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; and the Geriatrics Section, Boston University Medical Center, Boston University Schools of Medicine and Public Health, Boston Medical Center, Boston, MA.

Corresponding author: Mara A. Schonberg, MD, MPH, Beth Israel Deaconess Medical Center, 1309 Beacon, Office 202, Brookline, MA 02446; e-mail: mschonbe{at}bidmc.harvard.edu.

Purpose To examine outcomes of mammography screening among women 80 years to inform decision making.

Patients and Methods We conducted a cohort study of 2,011 women without a history of breast cancer who were age 80 years between 1994 and 2004 and who received care at one academic primary care clinic or two community health centers in Boston, MA. Medical record data were abstracted on all screening and diagnostic mammograms, breast ultrasounds and biopsies performed, all breast cancers diagnosed through December 31, 2006, and on sociodemographics. Date and cause of death were confirmed using the National Death Index.

Results The majority of patients (78.6%) were non-Hispanic white and 51.4% (n = 1,034) had been screened with mammography since age 80 years. Among women who were screened, eight were diagnosed with ductal carcinoma in situ, 16 with early stage disease (1.5%), two with late stage disease, and one died as a result of breast cancer. Many (110; 11%) experienced a false-positive screening mammogram that led to 19 benign breast biopsies, eight refused work-up, and three experienced a false-negative screening mammogram; 97 were screened within 2 years of their death from other causes. There were no significant differences in the rate, stage, recurrence rate, or deaths due to breast cancer between women who were screened and those who were not screened.

Conclusion The majority of women 80 years are screened with mammography yet few benefit. Meanwhile, 12.5% experience a burden from screening. The data from this study can be used to inform elderly women's decision making and potentially lead to more rational use of screening.

Supported by a Hartford Geriatrics Health Outcomes Research Scholars Award from the American Geriatrics Society Foundation for Health in Aging and by a National Institute on Aging K23 award (1K23AG028584-01A1; M.A.S.).

Presented in part at the National Meeting of the Society of Medical Decision Making, October 19-22, 2008, Philadelphia, PA.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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