Recommending mammography screening beyond 80 years of age: a time for caution

Evaluation of: Badgwell BB, Giordano SH, Duan ZZ et al.: Mammography before diagnosis among women age 80 years and older with breast cancer. J. Clin. Oncol. 26, 5-8 (2008). While strong scientific evidence of efficacy supports the recommendation of mammography screening up to the age of 74 years, the current recommendation of continuing screening up to or beyond the age of 80 years, issued by several guidelines, is not based on controlled evidence of screening efficacy, but simply on the assumption that mammography increases its accuracy with age and that mammography screening must be beneficial, providing that life expectancy is long enough to allow for the benefit to take place. In the present study, a large series of breast cancer patients aged 80 years or above was considered, demonstrating that mammography use is associated with less advanced stage at diagnosis and with better survival. The authors conclude that the opportunity for continuing screening beyond the age of 80 years, owing to its potential benefit, should be discussed with patients, particularly those without significant comorbidity, foretelling a longer life expectancy. Although their findings may also suggest a benefit in terms of mortality reduction, the clear presence of a healthy screening effect, lead time and overdiagnosis considerations call for major caution, since screening might be more detrimental than beneficial.