Women in their 70s and beyond should continue to have routine breast screening because their risk of getting the cancer rises with age, scientists have urged.
Women in the UK currently stop being invited to routine screening when they reach their 70th birthday, and a leading charity has warned many are ‘left in the dark’ afterwards.
But there is a ‘considerable incidence’ of breast cancer among women over 75, experts say – and almost half of cases in the UK (48 per cent) are in women over 65.
Experts say the benefits of screening women over the age of 75 would outweigh any disadvantages because of the scans’ life-saving potential.
Women between the ages of 50 and 70 are invited to routine mammograms every three years in the UK, but 25 per cent of breast cancer cases happen over the age of 75 – a recent study claimed the benefits of continuing screening would outweigh any disadvantages (stock image)
Researchers from the Elizabeth Wende Breast Center in New York analysed results from 763,256 mammography exams for their research.
They found out of 3,944 patients diagnosed with breast cancer from the scans, 616 of them were among women aged 75 or over – 16 per cent.
This was despite them making up a ‘relatively small percentage’ of the scans.
And Cancer Research UK data shows 25 per cent of breast cancer cases occur in women over the age of 75.
‘Our findings provide important data demonstrating that there is value in screening women over 75 because there is a considerable incidence of breast cancer,’ said Dr Stamatia Destounis, who ran the study.
The NHS currently invites women to routine screening every three years between the ages of 50 and 70.
The American Cancer Society in the US recommends women are screened between the ages of 45 and 75.
Once women pass the routine screening age the responsibility falls to them to arrange the mammogram scans with their doctor.
‘We regularly hear from women on our helpline who have been left in the dark about routine mammograms continuing past 70, when invitations to attend stop,’ said Dr Emma Pennery, clinical director at Breast Cancer Care.
‘They think they are no longer at risk of breast cancer. In fact, breast cancer risk increases with age and older women can request to continue routine screening up to any age.
‘Screening remains our best tool for detecting breast cancer at the earliest possible stage so it’s crucial that every woman eligible has all the information to make an empowered decision about whether to attend.’
In Dr Destounis’s study, as well as one in six of the cancers being diagnosed in women over the age of 75, a majority of them – 63 per cent – were grade two or three, meaning they are fast-growing and spread easily.
These types of cancer need urgent treatment or they can spread to other parts of the body and become life-threatening.
Dr Destounis added: ‘Most of the tumors found in this age group were invasive, and almost all of these patients – 98 percent – underwent surgery.
‘The benefits of screening yearly after age 75 continue to outweigh any minimal risk of additional diagnostic testing.’
She recommended women in good health should continue getting screened into their late 70s and beyond.
Mammogram scans are crucial to spotting cancer early because they can detect changes in the breast up to two years before a doctor can feel them.
The ages at which screening should be offered were called into question when, in 2009, the United States Preventive Services Task Force released guidelines stating there was not enough evidence to assess the benefits of screening over-75s.
Not all experts agree routine screening into old age is beneficial.
Georgina Hill, from Cancer Research UK, said: ‘Breast screening can save lives by detecting breast cancer early, but it will also mean cancers are detected and treated that may never have caused a problem in a women’s lifetime.
‘Overall, the evidence suggests that for women over 70 these harms outweigh the benefits.
‘But women over 70 can still take part in screening if they want to. It’s important that all women have clear and reliable information when deciding if they want to take part.
‘Although breast cancer risk increases with age, women of all ages should get to know what’s normal for their breasts and see their doctor if they notice an unusual or persistent change.
‘It’s probably not cancer, but if it is, finding it early can make a real difference.’
Dr Destounis and her team’s findings will be presented next week at the annual meeting of the Radiological Society of North America.
WHAT IS BREAST CANCER, HOW MANY PEOPLE DOES IT STRIKE AND WHAT ARE THE SYMPTOMS?
Breast cancer is one of the most common cancers in the world. Each year in the UK there are more than 55,000 new cases, and the disease claims the lives of 11,500 women. In the US, it strikes 266,000 each year and kills 40,000. But what causes it and how can it be treated?
What is breast cancer?
Breast cancer develops from a cancerous cell which develops in the lining of a duct or lobule in one of the breasts.
When the breast cancer has spread into surrounding breast tissue it is called an ‘invasive’ breast cancer. Some people are diagnosed with ‘carcinoma in situ’, where no cancer cells have grown beyond the duct or lobule.
Most cases develop in women over the age of 50 but younger women are sometimes affected. Breast cancer can develop in men though this is rare.
The cancerous cells are graded from stage one, which means a slow growth, up to stage four, which is the most aggressive.
What causes breast cancer?
A cancerous tumour starts from one abnormal cell. The exact reason why a cell becomes cancerous is unclear. It is thought that something damages or alters certain genes in the cell. This makes the cell abnormal and multiply ‘out of control’.
Although breast cancer can develop for no apparent reason, there are some risk factors that can increase the chance of developing breast cancer, such as genetics.
What are the symptoms of breast cancer?
The usual first symptom is a painless lump in the breast, although most breast lumps are not cancerous and are fluid filled cysts, which are benign.
The first place that breast cancer usually spreads to is the lymph nodes in the armpit. If this occurs you will develop a swelling or lump in an armpit.
How is breast cancer diagnosed?
- Initial assessment: A doctor examines the breasts and armpits. They may do tests such as a mammography, a special x-ray of the breast tissue which can indicate the possibility of tumours.
- Biopsy: A biopsy is when a small sample of tissue is removed from a part of the body. The sample is then examined under the microscope to look for abnormal cells. The sample can confirm or rule out cancer.
If you are confirmed to have breast cancer, further tests may be needed to assess if it has spread. For example, blood tests, an ultrasound scan of the liver or a chest x-ray.
How is breast cancer treated?
Treatment options which may be considered include surgery, chemotherapy, radiotherapy and hormone treatment. Often a combination of two or more of these treatments are used.
- Surgery: Breast-conserving surgery or the removal of the affected breast depending on the size of the tumour.
- Radiotherapy: A treatment which uses high energy beams of radiation focussed on cancerous tissue. This kills cancer cells, or stops cancer cells from multiplying. It is mainly used in addition to surgery.
- Chemotherapy: A treatment of cancer by using anti-cancer drugs which kill cancer cells, or stop them from multiplying
- Hormone treatments: Some types of breast cancer are affected by the ‘female’ hormone oestrogen, which can stimulate the cancer cells to divide and multiply. Treatments which reduce the level of these hormones, or prevent them from working, are commonly used in people with breast cancer.
How successful is treatment?
The outlook is best in those who are diagnosed when the cancer is still small, and has not spread. Surgical removal of a tumour in an early stage may then give a good chance of cure.
The routine mammography offered to women between the ages of 50 and 70 mean more breast cancers are being diagnosed and treated at an early stage.
For more information visit breastcancercare.org.uk or www.cancerhelp.org.uk