Image of Rachel Freedman, M.D.

Guidelines developed by a national panel of experts are now available for mammography screenings in older breast cancer survivors — a first, according to the authors. 

The guidance, published Thursday in JAMA Oncology, offers a framework for discussion between older survivors and clinicians, and is aimed at correcting the inconsistent use of mammography in this population — especially when life expectancy is limited, said lead author Rachel A.Freedman, M.D., MPH, of Dana-Farber Cancer Institute. 

Freedman and colleagues recommend that:

  • Discontinue routine mammograms for survivors with a life expectancy of fewer than five years
  • Consider stopping screening for those with a five- to 10-year life expectancy
  • Continue mammography for those whose life expectancy is greater than 10 years

The guideline panel included 18 clinicians with expertise in breast cancer primary care, geriatrics, radiology and survivorship, as well as nursing experts, and a group of patients. 

The panel’s review of scientific literature confirmed that most older breast cancer survivors have a low risk for breast cancer overall and that mammography offers little to modest clinical benefit for many older women, the authors reported. An additional review of the pluses and minuses of mammography found that a key downside is false-positives, patient anxiety related to diagnostics, and overtreatment, they concluded.

“There has been little guidance on how to tailor screening for older survivors — what role life expectancy, risk of recurrence, patient preferences, or the tradeoffs associated with mammography should play,” Freedman said. 

“With the number of older women who will be diagnosed with breast cancer expected to increase in the coming years, it’s important that we find ways to individualize decisions for each patient’s circumstances and preferences,” she added.

The authors will also include print materials to share with survivors, helping them to gauge their own risk of cancer recurrence and weigh benefits and drawbacks of mammography.