Making Decisions About Screening Mammography in Older Women:  Comment on “Older Patient Experiences in the Mammography Decision-Making Process”

The US Preventive Services Task Force notes that there are insufficient data to recommend breast cancer screening among women older than 70 years. Yet, as Walter¹ points out, older women have a high incidence of breast cancer, screening does not suddenly stop being effective in older women, and many live long enough to benefit from screening. On the other hand, the benefit of screening is lower in older women with a life expectancy less than 10 years, and the risk of harm, including false-positive results and overdiagnosis, is high. Thus, among women older than 70 years, those who are relatively healthy and have at least a 5-year life expectancy are likely to benefit, while frail older women are likely to be harmed and should not undergo mammography. This situation requires that clinicians individualize the decision regarding breast cancer screening in older women. However, this article by Fox et al suggests that clinicians do not alter their recommendations for breast cancer screening based on age or health status and overwhelmingly recommend screening.