Recently, Breast Cancer News reported on a new study questioning the benefit of endocrine therapy in elderly women with low risk hormone receptor positive breast cancer. Now, a study conducted by a research team at Leiden University Medical Centre, Netherlands, suggests that mass screening for breast cancer in women above 70 may not offer as many benefits as it does costs, according to a recent press release.
Breast cancer is the most common cause of death by cancer in women worldwide. In addition, a steady median increase in the aging of the population is also leading to an increase in women diagnosed with the disease.
At the same time, considering the older population, both over diagnosis and over treatment needs to be considered by the medical community, according to the research team, since treatments and therapies for breast cancer may represent loss of quality of life and heavy side effects that are not worth the risk for older patients.
In 1998, the Netherlands established that all women from 69 to 75 (a limit recently reviewed for women above 75) should undergo screening tests for breast cancer, even though this decision was made with no strong evidence to back it up, due to the lack of a relevant sample of the age group in previous studies.
Armed with these data, researchers wanted to test the effectiveness of the mass screening policy in reducing late stage cancers in female population above 70.
The group of scientists listed all new cases of breast cancer between 1995 and 2011 using the Netherlands Cancer Registry, and then made a separate analysis by periods of time; one before the introduction of the Dutch national screening program (1995-1997), a second study (1998-2002), and a third (2003-2011), totaling of 25,500 in all.
Scientists then included 13,000 women aged 76-80 to assess whether there had been changes in breast cancer incidence among older women non-eligible for national screening.
From their analysis, researchers verified that in the 70-75 year-old group, new cases of early breast cancer increased significantly after the national screening program, from 248.7 to 362.9 out of 100,000 women.
There was also a relevant decrease in the numbers of new cases of advanced breast cancer, even though the total decrease was minimal.
In the group of 76-80, new cases of early breast cancer had little decrease, and those diagnosed with advanced forms of the disease remained the same.
Based on these numbers, researchers estimated that for each advanced stage cancer detected by screening in the 70-75 group, around 20 extra early stage cancer were also diagnosed, equal to being “over diagnosed,” according to the study.
Taking into consideration the study and the impact of breast cancer treatment in older women, the team responsible for the research suggests a personalized decision, based on each patient’s characteristics, rather than a mass approach.