sdestounis@ewbc.com

To review outcomes of screening mammography performed in women 75 and over to determine the rate of cancer diagnosed and associated histology and surgical excision performed.

Patients 75 years of age and over who presented for screening mammography and underwent biopsy with resultant malignant pathology were retrospectively collected and analyzed to record patient demographics, lesion information, pathology results and treatment. Cases of non-breast malignancy, cases of breast cancer diagnosed by modality other than mammography, and cases with missing or incomplete records were excluded.

From 2007-2016 there were a total of 679,168 screening appointments, with 3,480 patients diagnosed with screen-detected cancers (5.1/1000). 68,218 (10%) screenings were performed in women aged 75 and over; 530 of these women were diagnosed with 560 breast cancers, for a cancer detection rate of 7.8/1000. Average patient age 80.3 (range 75-98). Lesions most frequently presented as a mass (74%). A large majority (81%) of the malignancies diagnosed were invasive; 55.7% grade 2 or 3. Positive lymph nodes were reported at surgical excision in 7.0% of patients. Tumor stage was largely stage 0 or 1 (64%); 12% were determined to be stage II or III. 98% of cancers were surgically excised; twelve cancers were not due to advanced patient age or overall degraded patient health.

For the relatively small percentage of our screening population that women 75 and over comprise (10%), the patients diagnosed in this population made up 16% of all patients diagnosed with screen-detected cancers, a substantial cancer detection rate (7.8/1000). Most of the cancers diagnosed were low grade, a significant number were invasive (81%), over half were grade 2 or 3, and a majority were lower stage (0 or I). Most (98%) underwent surgical excision, suggesting that most women 75 and over are in good health and want to pursue surgical excision. Screening mammography should be performed in this age group given the incidence of breast cancer that exists.

Ongoing debate exists regarding the age to cease screening mammography, citing lack of research in the aging population. Our study demonstrates the value of screening women 75 and over.