Breast Cancer Screening After 69?

The district women’s association Friesland-Wilhelmshaven and the equal opportunities commissioner of the district of Friesland put this topic up for discussion

Mammography: An X-ray is supposed to reveal signs of burst cancer

© Mauritius / BSIP

The questioners from Lower Saxony also give the answer right away: Yes, absolutely! So far, health insurances have only paid women between the ages of 50 and 69 for a mammography, an x-ray of the breasts. It is designed to detect cancer in women who have no symptoms.

The "MammoBis75" initiative is now calling for the screening test to be open to women aged up to 75 in the future. A corresponding application was submitted to the Petitions Committee of the Bundestag - the activists from Friesland have collected over 80,000 signatures. A hearing is to take place in autumn and, ultimately, a recommendation to the Bundestag.

Targeted prevention of breast cancer

Women over the age of 70 live an average of 17 years today, and the number of deaths from breast tumors is steadily increasing (see graph). In countries like France and the Netherlands, which have similar screening programs, the age limit for mammography has been 75 years for a long time.

But do older women actually benefit from it? Here you can find out what scientific studies and the cancer epidemiologist Professor Alexander Katalinic have to say about it.

Professor Alexander Katalinic is a professor at the Institute for Social Medicine and Epidemiology at the University of Lübeck

© Mika Katalinic

Women who notice a change in their breasts or feel a lump should definitely see a doctor regardless of the screening. In such cases, the health insurance pays for the mammography - regardless of the patient's age.

A recent study by Harvard University in Boston, USA, found that women up to the age of 75 benefit from screening. In this group, one in 1,000 women died from breast cancer less than those who had stopped participating in the screening earlier. At an even older age, there was no longer any evidence of benefit. The evaluation of a large US registry also showed that the death rate from breast cancer depends heavily on other health.

"Provide intensive information about the advantages and disadvantages"

Professor Katalinic, is there any scientific evidence that screening over the age of 69 prevents breast cancer deaths?

An international panel of experts from the World Health Organization sees this as proven. A guideline of the European Commission also recommends two examinations every three years between the ages of 70 and 74.

Should Germany follow these recommendations?

I think that makes sense. However, this must be combined with a particularly intensive explanation of the advantages and disadvantages.

What are the downsides?

There is also overdiagnosis in mammography screening. In other words, a discovered breast cancer that might never have been recognized and would never have affected the woman. Overdiagnosis is increasing in older women because some die beforehand from causes other than breast cancer.

Treatment could then be dispensed with.

The problem is that these overdiagnoses can hardly be seen in the individual woman. Since every cancer should be treated, some patients inevitably have to undergo unnecessary, stressful therapies.

The German screening program: an initial assessment

In women screening ages 50 to 69, the rate of advanced tumors in 2013-14 was 23 to 28 percent lower than just before the program began. Associated with this is the - so far unproven - hope for better chances of recovery.

Breast Cancer Deaths by Age

© W & B / Astrid Zacharias

17 to 19 percent of the cases detected in the screening are likely to be overdiagnosed: the cancer detected would never have affected the women. The rate of overdiagnosis is calculated from studies. However, it cannot be predicted whether an individual woman will be affected. Therefore, unnecessary therapies may be used.
Source: International Journal of Cancer 2019

Conclusion

Some data suggest that women between the ages of 70 and 75 can benefit from mammography screening - especially if they are still in good health. At this age, however, the proportion of overdiagnoses also increases. Women should definitely seek medical advice and then make their decision after weighing up the advantages and disadvantages.