Should an 80-year-old woman with a history (hx) of benign breast mass continue to have mammograms?

Mammography Screening for an 80-Year-Old Woman with History of Benign Breast Mass

For an 80-year-old woman with a history of benign breast mass, mammography screening should continue only if she has good overall health and a life expectancy of at least 10 years. 1, 2

Decision Algorithm for Continuing Mammography at Age 80

Key Factors to Consider:

1. Life Expectancy Assessment

   • Primary determining factor: life expectancy ≥10 years 1, 2
   • Evaluate using mortality indices that incorporate:
     • Age
     • Comorbidities
     • Functional status

2. Health Status Evaluation

   • Overall good health with minimal comorbidities 1
   • Ability to tolerate potential follow-up procedures
   • Absence of life-limiting conditions

3. History of Benign Breast Mass

   • A history of benign breast mass alone does not automatically place the patient in a high-risk category
   • This history may warrant continued surveillance but must be balanced against age-related considerations

Evidence-Based Rationale

• The American Cancer Society (ACS) recommends that "women should continue screening mammography as long as their overall health is good and they have a life expectancy of 10 years or longer" 1

• The American College of Radiology (ACR) emphasizes that "there is no upper age limit agreed upon for screening mammography" but recommends basing decisions on life expectancy and competing comorbidities rather than age alone 1

• Mortality reduction from screening mammography requires years before being fully attained, making the 10-year life expectancy threshold critical 1

• Research shows that approximately 28.5% of breast cancer survivors receive mammography during their last year of life, suggesting potential overuse in women with limited life expectancy 3

Benefits vs. Harms at Age 80+

Benefits:

• Potential mortality reduction if life expectancy exceeds 10 years
• Psychological reassurance (ranked as a highly important factor by older women) 4

Harms:

• False positives (11% of screened women >80 experience false-positive results) 5
• Unnecessary biopsies (approximately 1.9% of screened women >80) 5
• Overdiagnosis (30% of screen-detected cancers in older women may not have affected their lifetime) 6
• Overtreatment with associated risks that increase with age 6

Common Pitfalls to Avoid

1. Continuing screening based solely on habit

   • Despite habit being a strong influencing factor for older women, it should not override clinical judgment 4

2. Failing to have explicit discussions about stopping screening

   • Doctor's recommendations are the most influential factor in older women's screening decisions 4

3. Overestimating benefit in women with limited life expectancy

   • Only approximately 2 of 1,000 women screened from age 70-79 may avoid breast cancer death 6

4. Underestimating the psychological impact of stopping screening

   • Reassurance is a highly ranked factor influencing older women's decisions to continue screening 4

Conclusion

The decision to continue mammography screening in an 80-year-old woman with a history of benign breast mass should be primarily based on her overall health status and estimated life expectancy. If her life expectancy is less than 10 years, the potential harms likely outweigh the benefits, and screening should be discontinued. If her life expectancy exceeds 10 years and she is in good health, continued biennial screening may be appropriate.