More than 240,000 women in the United States will be diagnosed with breast cancer this year, and most will likely start treatment immediately. But according to new research, that may be a mistake.
Breast cancer in women ages 70 to 85 is often overdiagnosed, which may lead to unwarranted worry and unnecessary and intensive treatments such as surgery and chemotherapy that don’t improve quality of life.
“Overdiagnosis refers to a phenomenon where we find breast cancers through screening that never would have caused symptoms,” said Dr. Ilana Richman, the paper’s lead author and an assistant professor of medicine at the Yale School of Medicine. “Overdiagnosis can occur when cancers grow very slowly or if a person’s life expectancy is short.”
Reevaluating Screening Practices for Older Patients
Published in the Annals of Internal Medicine, the research underscores the importance of reevaluating screening practices and engaging in informed discussions with patients.
Although mammography is a standard screening method for breast cancer, the study highlights a gap in research for older women. Individuals over 74 have frequently been excluded from large randomized screening trials, leaving uncertainty regarding the full spectrum of screening benefits and potential drawbacks.
The study, involving 54,635 women aged 70 and above, analyzed breast cancer diagnoses and related fatalities over a 15-year follow-up period.
The results indicate a significant likelihood of overdiagnosis among older women. Specifically, an estimated 31 percent of women aged 70 to 74 were overdiagnosed, as well as 47 percent of those aged 75 to 84 and 54 percent of those aged 85 and older.
“That finding points to a real need for better tools to identify which women may benefit from screening and which breast cancers are unlikely to be progressive so that we can avoid overtreatment,” Dr. Richman said.
The Challenge of Overdiagnosis: Risks Versus Benefits
There are two primary challenges to putting the study findings into clinical practice.
First, balancing the risks of overdiagnosis against potential screening benefits is difficult on an individual basis, given the current uncertainties in the data, according to Dr. Richman.
Second, discussing the concept of overdiagnosis with patients presents communication difficulties, she added. As an abstract, unfamiliar idea that can’t be directly observed, it doesn’t fit neatly into busy clinic visits.