The January guidelines, which were published in JAMA Oncology, offer recommendations for survivors depending on anticipated life expectancy. The guidelines are specifically for survivors age 75 and older.
While mammograms can detect cancer, lead author Rachel A. Freedman, MD, MPH, medical director of the Dana-Farber Cancer Institute Cancer Care Collaborative and an associate professor of medicine at Harvard University, tells Verywell that sometimes, the scans find growths that are not cancerous. These findings can lead to unnecessary anxiety, stress, testing, and treatments.
Current Mammography Guidelines
There is currently no official guidance on mammograms for older breast cancer survivors. However, the standard recommendation for all breast cancer survivors is annual surveillance.
“We know that the benefits of screening mammography decrease with increasing age and when life expectancy is short,” Crystal Fancher, MD, a surgical breast oncologist at the Margie Petersen Breast Center at Providence Saint John’s Health Center and assistant professor of surgery at the John Wayne Cancer Institute in California, tells Verywell.
Fancher says that doctors “talk frequently” about when to stop breast cancer screening in the average-risk woman—usually when their life expectancy is less than 10 years. “In the population with a history of previous breast cancer, these guidelines were not as clear and we may be screening this aging population more than is needed," Fancher says.
In terms of how mammograms are used across the country, Freedman says there is “tremendous variability”—even when a person’s life expectancy has been shortened by medical conditions that are not related to their breast cancer history.
To address the gap, Freedman says that she and her fellow researchers “brought experts together from multiple disciplines, sought input from clinicians and patients, and derived a set of guidelines served to fit this purpose: helping clinicians and women make individualized decisions on mammography after reviewing the benefits and harms of testing, patient preferences, and breast cancer history/risk for new cancers.”
Creating New Guidelines
Experts in breast cancer primary care, geriatrics, radiology, survivorship, and nursing consulted data on breast cancer and gathered input from an 18-member panel of patients. The group also reviewed available research on the benefits and downsides of mammography.
The new guidelines recommend that providers stop routine mammograms in breast cancer survivors based on anticipated life expectancy. Specifically, the guidelines advise:
Stopping routine mammograms in survivors with a life expectancy of fewer than five years. Considering stopping screening in survivors with a five to 10-year life expectancy. Continuing mammography for survivors with a life expectancy of more than 10 years.
Patients would also be given printed materials to help them determine their risk of having recurrent breast cancer and to help them to weigh the potential benefits and drawbacks of mammography with their provider.
Through their review, the researchers confirmed that most older breast cancer survivors had a low risk for breast cancer in either breast. The review also found that, while the benefits of screening in older patients are not well defined, research suggests mammograms offer little benefit for many older patients.
“How and when to stop mammograms in older breast cancer survivors can be challenging for clinicians and their patients for many reasons, including a lack of guidelines to support these decisions,” Freedman says.
What Doctors Think About Mammograms
“Mammograms are not simply beneficial for all women forever,” Freedman says. “Many patients don’t realize that having a mammogram is actually a decision that deserves thought and personalization, that mammograms do not improve longevity indefinitely, and that there are harms to screening as well.”
The potential risks associated with mammograms, Fancher says, include:
False-positivesAnxietyOver-treatment (like requiring an unnecessary biopsy)
“The idea is to mitigate some of the risks in this aging population by discontinuing imaging screening once there may no longer be a great benefit from imaging,” Fancher says.
Richard Reitherman, MD, PhD, medical director of breast imaging at MemorialCare Breast Center at Orange Coast Medical Center in California, tells Verywell that patients should not feel stressed about deciding whether or not to continue with mammograms. The decision “about continuing mammography is event-specific, that is, you don’t need to make a decision for the rest of your life—you simply make it for the current year," he says.
The guidelines are “not meant to take mammograms away from women but are really to help provide support for the patient and clinician to have an informed and tailored decision process," Freedman says. “Women can still have mammograms if they prefer, but perhaps if they have the full information, they would choose another path.”
She hopes that these new guidelines will help doctors and patients. “We anticipate our guidelines will enhance and support clinical care substantially, given how common breast cancer is in older women—30% of diagnoses every year in the U.S. occur in women age 70 plus,” she says. “We hope they will lead to a change in the approach and discussion for these patients, making it a more informed process.”
