Posted on October 7, 2011
The traditional methods for breast cancer screening involve the use of annual mammograms and monthly self-checks. These preventive measures have resulted in a dramatic increase in breast cancer survival for most women, except those over 70. Over the next 30 years, the number of the 85+ population in the United States is expected to quadruple. Life expectancy for women at 70 TODAY is another 15 years. Recent studies have been conducted regarding the survival rate for women diagnosed with breast cancer and many commonalities have been identified.
1. There is still a lot of controversy regarding what age women should discontinue routine mammograms.
2. According to MayoClinic.com, a woman’s chance of developing breast cancer increases after she reaches the age of 60.
3. More than 50 percent of breast cancers occur in women 65 years of age and older.
4. As many as 50 percent of women 65 years of age and older who develop breast cancer die of the disease.
5. A woman’s chance of being diagnosed with breast cancer:
From age 30-39 . . . . . . 1 out of 229
From age 40-49 . . . . . . 1 out of 68
From age 50-59 . . . . . . 1 out of 37
From age 60-69 . . . . . . 1 out of 26
From age 70-85. . . . . . 1 out of 8
Reasons for this increased morbidity and mortality in breast cancer for older women can be attributed to lower screening rates screening rates and a difference in opinion about how to approach treatment options. Until recently, there were no guidelines available regarding screening over senior women over 70. Now the American Geriatrics Society encourages screening mammography for women younger than 85 who have at least 5 years’ life expectancy and for healthy women 85 and older who have excellent functional status or who feel strongly about the benefits of screening. It is important to note that the AGS does not recommend regular mammograms for seniors with severe cognitive deficits or life limiting conditions. As with all diagnostic tools, there is a chance of a false positive which would require more office visits and possibly uncomfortable procedures to investigate a positive. Many well-intentioned spouses, adult-children or other caregivers may be taking the person in for unnecessary mammograms out of a sense of duty and care, inadvertently causing distress, both psychologically and physically.
Historically, most studies have focused on the results of diagnosis and treatments for senior women up to the age of 70. As a result, frequency of these screenings is still controversial with opinions varying between being screened every 1 to 3 years. However, with a 1 in 8 chance of being positively diagnosed, a regular screening schedule should be considered. One way to determine the correct frequency is to evaluate your risk factors:
• Are you overweight?
• Have you had prolonged exposure to estrogen? i.e., early onset of puberty (before 12 years of age), first child after 30, late menopause (after 55 years of age), hormone replacement therapy.
• History of excessive alcohol use?
• Do you have a history of smoking?
• Is there a family history of breast cancer?
If you are diagnosed with breast cancer, treatment options should not be based on age alone. Age is an arbitrary measure. If you are still active with a good quality of life, insist on an open discussion with your physician about the type of tumor you have and the most effective approach to treatment. Treatment should be tailored to YOU specifically. Be completely informed of ALL of your options and evaluate the risks and benefits to your overall quality of life. Many women have received less aggressive treatment after diagnosis if they are over 70. The fear has been that age would decrease tolerance to such treatments. These are valid concerns, all risk factors associated with your individual health profile should be evaluated and treatments should be adjusted to reduce unnecessary toxicity to your body, but that does not mean to avoid a more aggressive treatment. Studies show that if detected early enough and treated appropriately, the survival rates of senior women are similar to those of younger women.
The debate continues, and over the next 5-10 years current studies and the data that is gathered will possibly reveal an effective breast cancer prevention/detection/treatment protocol for senior women in their 70s and beyond. For now (and probably, always), it is best to take a proactive approach to your own care, an approach that reflects your wishes and needs. Make a plan and share it with a trusted primary care provider who will respect and honor that plan.