Octogenarians and Older May Benefit from Regular Mammography
By Todd Neale
HOUSTON, 24 april 2008-- For octogenarian women and older, regular screening mammography may translate into earlier breast cancer diagnoses and better disease-specific survival.
So revealed a retrospective database study of 12,358 women 80 or older with breast cancer, Gildy Babiera, M.D., of the University of Texas M. D. Anderson Cancer Center here, and colleagues, reported online in the Journal of Clinical Oncology. The study will be published in the May 20 print issue.
Each mammogram received within five years prior to diagnosis was associated with a 37% decreased risk of having late-stage (IIb to IV) disease (OR 0.63, 95% CI 0.63 to 0.67).
Five-year breast cancer-specific survival rates were 94% for regular mammography users, 88% for irregular users, and 82% for nonusers (P<0.0001).
However, non-breast cancer-related survival was also associated with mammography use, "suggesting a bias for healthier patients to undergo mammography," they said.
Nevertheless, they concluded, "healthcare providers should consider discussing the potential benefits of screening mammography with their older patients, particularly for those without significant comorbidity."
Randomized trials on the use of screening mammography have excluded patients older than 74, even though the proportion of the population who are 80 and older is growing, the researchers said.
Current guidelines on screening for breast cancer in older patients vary in their recommendations, with some considering life expectancy, a variable that is difficult to predict, they said.
Dr. Babiera and colleagues analyzed data from the Surveillance, Epidemiology, and End Results (SEER) -- Medicare linked database on women 80 and older who were diagnosed with breast cancer from 1996 through 2002.
Forty-nine percent of the patients had not had a screening mammography during the five years before diagnosis. Twenty-two percent had three or more screenings spaced at least 11 months apart (regular users) and 29% had one or two (irregular users).
From 1996 to 2002, regular mammography use increased from 17.2% to 25.8% and nonuse declined from 53% to 45.9%.
Whites and those who had more education, were married, and had a higher income were more likely to receive regular screenings.
Nonusers had poorer baseline health than regular users, as indicated by higher scores on the Charlson comorbidity index (P<0.0001).
Nonusers also had the highest mean tumor size (5.22 cm, 95% CI 4.57 to 5.86) compared with irregular (3.4 cm, 95% CI 2.70 to 4.10) and regular (2.9 cm, 95% CI 2.15 to 3.65) users.
Regular users had a larger percentage of stage I breast cancer compared with the rest of the cohort, and irregular and nonusers had higher percentages of stage II to IV disease.
Late-stage disease was more common among blacks (OR 1.71, 95% CI 1.45 to 2.02) and those of "other" race (OR 1.07, 95% CI 1.06 to 1.52) than among whites, even after adjusting for mammography use.
A score of 1 on the Charlson comorbidity index was also associated with higher likelihood of late-stage cancer (OR 1.48, 95% CI 1.30 to 1.69).
"Our findings are consistent with those of other reports demonstrating improvements in stage presentation for older women undergoing routine mammography, although none has focused specifically on individuals ≥80 years of age," the researchers said.
They acknowledged some limitations to the study, including the difficulty in separating screening and diagnostic mammography, the inability to account for screenings paid for outside of Medicare, and the fact that the patients in the database used in the study are more likely to be urban, affluent, and non-white compared with the general population.
They also pointed out the potential role of selection bias. "Specifically, this selection bias reflects the tendency for healthier patients, who have longer life expectancies, to undergo screening mammography."
"Despite these limitations," they said, "the SEER-Medicare database provides data on a large and geographically diverse population that can answer important questions pertaining to screening in the older adult population, especially in lieu of the exclusion of older adult populations from large controlled trials."
By Todd Neale
HOUSTON, 24 april 2008-- For octogenarian women and older, regular screening mammography may translate into earlier breast cancer diagnoses and better disease-specific survival.
So revealed a retrospective database study of 12,358 women 80 or older with breast cancer, Gildy Babiera, M.D., of the University of Texas M. D. Anderson Cancer Center here, and colleagues, reported online in the Journal of Clinical Oncology. The study will be published in the May 20 print issue.
Each mammogram received within five years prior to diagnosis was associated with a 37% decreased risk of having late-stage (IIb to IV) disease (OR 0.63, 95% CI 0.63 to 0.67).
Five-year breast cancer-specific survival rates were 94% for regular mammography users, 88% for irregular users, and 82% for nonusers (P<0.0001).
However, non-breast cancer-related survival was also associated with mammography use, "suggesting a bias for healthier patients to undergo mammography," they said.
Nevertheless, they concluded, "healthcare providers should consider discussing the potential benefits of screening mammography with their older patients, particularly for those without significant comorbidity."
Randomized trials on the use of screening mammography have excluded patients older than 74, even though the proportion of the population who are 80 and older is growing, the researchers said.
Current guidelines on screening for breast cancer in older patients vary in their recommendations, with some considering life expectancy, a variable that is difficult to predict, they said.
Dr. Babiera and colleagues analyzed data from the Surveillance, Epidemiology, and End Results (SEER) -- Medicare linked database on women 80 and older who were diagnosed with breast cancer from 1996 through 2002.
Forty-nine percent of the patients had not had a screening mammography during the five years before diagnosis. Twenty-two percent had three or more screenings spaced at least 11 months apart (regular users) and 29% had one or two (irregular users).
From 1996 to 2002, regular mammography use increased from 17.2% to 25.8% and nonuse declined from 53% to 45.9%.
Whites and those who had more education, were married, and had a higher income were more likely to receive regular screenings.
Nonusers had poorer baseline health than regular users, as indicated by higher scores on the Charlson comorbidity index (P<0.0001).
Nonusers also had the highest mean tumor size (5.22 cm, 95% CI 4.57 to 5.86) compared with irregular (3.4 cm, 95% CI 2.70 to 4.10) and regular (2.9 cm, 95% CI 2.15 to 3.65) users.
Regular users had a larger percentage of stage I breast cancer compared with the rest of the cohort, and irregular and nonusers had higher percentages of stage II to IV disease.
Late-stage disease was more common among blacks (OR 1.71, 95% CI 1.45 to 2.02) and those of "other" race (OR 1.07, 95% CI 1.06 to 1.52) than among whites, even after adjusting for mammography use.
A score of 1 on the Charlson comorbidity index was also associated with higher likelihood of late-stage cancer (OR 1.48, 95% CI 1.30 to 1.69).
"Our findings are consistent with those of other reports demonstrating improvements in stage presentation for older women undergoing routine mammography, although none has focused specifically on individuals ≥80 years of age," the researchers said.
They acknowledged some limitations to the study, including the difficulty in separating screening and diagnostic mammography, the inability to account for screenings paid for outside of Medicare, and the fact that the patients in the database used in the study are more likely to be urban, affluent, and non-white compared with the general population.
They also pointed out the potential role of selection bias. "Specifically, this selection bias reflects the tendency for healthier patients, who have longer life expectancies, to undergo screening mammography."
"Despite these limitations," they said, "the SEER-Medicare database provides data on a large and geographically diverse population that can answer important questions pertaining to screening in the older adult population, especially in lieu of the exclusion of older adult populations from large controlled trials."
Primary source: Journal of Clinical OncologySource reference:Badgwell B, et al "Mammography before diagnosis among women age 80 years and older with breast cancer" J Clin Oncol 2008; DOI: 10.1200/JCO.2007.12.8058.
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