An expert panel has proposed the first set of recommendations for surveillance mammography for women over 75 years old who previously had breast cancer, emphasizing individualized discussions and shared decision-making between patients and providers.
Current guidelines do not outline how surveillance mammograms for older women who have survived breast cancer should be carried out, especially in cases where life expectancy is lower.
“We have no consensus, patients have no education on it and it is always hard to stop testing when people feel attached to it,” Rachel Freedman, MD, MPH, of the Dana-Farber Cancer Institute in Boston, told Healio. “My goal in this work is to bring experts together, provide clinical support for patients and their clinicians and help navigate an individualized decision on how and when to stop routine mammograms as we age.”
Freedman and colleagues set out to craft guidelines for a tailored approach to routine surveillance mammograms for older women who had experienced breast cancer.
The team searched through scientific literature on breast cancer among older women as well as the pros and cons of mammograms. A multidisciplinary panel then crafted consensus recommendations for this subpopulation. With clinician focus groups chiming in and a critical review by the International Society for Geriatric Oncology, the 18-member panel put together a final set of guidelines with attention to an individual’s breast cancer risk, age, life expectancy and preferences.
According to their literature review, most women older than 75 who have had breast cancer in the past have a low risk of developing cancer in the breast again. Surveillance mammography offered little benefit to older women and came with negative outcomes, such as anxiety, false positives and unnecessary treatment.
The final guidelines recommend that women with a history of breast cancer who have a life expectancy of less than five years should discontinue routine mammography. This applies even to women with a history of high-risk cancers. The panel advised considering discontinuation of routine mammography for women with a life expectancy of between five and 10 years and continuing routine scans when life expectancy is longer than 10 years. Further, clinical breast exams and diagnostic mammography to clarify any clinical symptoms should continue.
Ultimately, decisions regarding surveillance mammography must be personalized for each individual after taking into account the harms and benefits.
“It is anticipated that these expert guidelines will enhance clinical practice by providing a framework for individualized discussions, facilitating shared decision-making regarding surveillance mammography for breast cancer survivors 75 years or older,” wrote the researchers.
Click here to read the study abstract in JAMA Oncology.
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