Screening is also recommended for 70-75-year-olds

Salzgitter. Women between the ages of 70 and 75 can also benefit from the Mammography Screening Program (MSP) for early detection of breast cancer. This is the result of a current scientific report from the Federal Office for Radiation Protection (BfS). The BfS is therefore in favor of an extension of the age limit for participants to 75 years. Until now, the limit has been 69 years. As the BfS notes in the initial situation, breast cancer is the most frequent cancer and also the most frequent cause of cancer death among women in Germany. Advanced breast carcinomas are often perceived as lumps or induration in the breast, but they are often not clinically noticeable, especially in the early stages. The prognosis for breast cancer in stages I and II is significantly better than in later stages, so early detection plays an important role. The MSP for 50- to 69-year-old women had already shown that this preventive measure could reduce breast cancer mortality in this age group by about 20 to 30 percent. In this report, the BfS assesses the benefits and risks of continuing MSP for women over 70 in Germany.

Statements so far not statistically significant

The data from the randomized clinical trials (RCT) considered in the report indicated that biannual mammography screening in women aged 70 to 74 could reduce breast cancer mortality, according to the BfS. “However, the data are limited so far and the observed positive effect is not statistically significant due to the small numbers. No reliable statement can be made about the assessment of all-cause mortality, as the studies were not designed for this. There are no separate results on breast cancer mortality from RCTs for women over 75. Therefore, on the basis of data from RCTs, no statement can be made about a benefit of screening for the age group of women over 75,’ the report states.

It seems plausible to assume that the benefit demonstrated for women with a screening age up to 69 years will continue for a few more years if they are screened after their 70th birthday. “Model studies from Germany, which were carried out for the IQWiG assessment, and from the USA support this assumption. However, the risk of overdiagnosis of a breast carcinoma increases with increasing age. B. would not have been clinically noticed due to other causes of death,” write the authors. In terms of quality of life and the extent of invasive procedures and related complications, a similar extent can be assumed as in women with a screening age of less than 70 years, despite the lack of age-specific evidence. Due to the better detectability of lesions in adipose breast tissue in older women, there may be fewer false-positive findings and unnecessary invasive diagnostic measures.

Signs indicate opportunistic screening

Evaluations based on MSP data showed that early tumor stages were also detected well in the screening among the older participants. Analysis of data from the German Cancer Registry from women aged 60 to 69 at screening supported this result. They also suggested that “opportunistic screening be performed in women over 70 years of age because precancerous lesions are detected in this age group which are almost exclusively asymptomatic and therefore usually only identified by imaging.”

As the BfS points out, the European guidelines for early detection of breast cancer also indicate the limited evidence base and therefore give a conditional recommendation to continue screening in 70 to 74-year-olds as part of organized MSP. In its final report on the review of the age limits in the MSP, IQWiG sees an indication of an advantage of mammography screening compared to no screening in women between 70 and 74 years of age.

“The BfS particularly assesses the aspect of radiation protection and the possible benefit in relation to the radiation risk. The radiation-related cancer risk decreases significantly with increasing age and plays practically no role for screening examinations from the age of 70. To achieve a risk-benefit ratio of ten for a screening at age 50 to 75 requires a reduction in breast cancer mortality of almost four percent. This compares with the corresponding minimum value for screening at age 50 to 69 (about 3.5 percent). In the unlikely event that a woman first participates in the screening from the age of 70, the minimum value is less than one percent. From a radiation protection point of view, it is justified to continue screening in women up to the age of 75,” write the authors in their report.

A continued willingness to participate is expected

With a screening interval of two years, all women over the age of 70 could be offered three additional examinations. Since a potential extension of the age limit would primarily affect women who had already participated in MSP at a younger age, it was not expected that the willingness to participate would decrease significantly after the age of 70. Even with current beneficiaries, participation rates are shown to be higher when it comes to follow-up appointments and remain relatively stable with increasing age.

The BfS conclusion is: “Women who wish to continue early detection of breast cancer using mammography should have this option in the quality-assured MSP, also not to encourage opportunistic screening. Taking into account the higher risk of overdiagnosis with increasing age and the overall limited body of evidence, comprehensive information is essential for women aged 70 years and over, especially given the greater uncertainty in this age group regarding the individual benefits and harms.For women over 75 years, there are no reliable study data for a continuation of mammography screening. A reassessment of the question in this report will be carried out regularly after five years in accordance with the StrlSchGVwV early detection, in case of significant new findings even earlier.”

Leave a Comment