Women with Limited Life Expectancy

Achieving balance between the benefits and harms of screening is especially important for women with a life expectancy of no longer than 5 years. Such women might have end-stage renal disease, severe dementia, terminal cancer, or severe functional dependencies in activities of daily living. Early cancer detection and prompt treatment are unlikely to reduce morbidity or mortality within the woman's 5 years of expected survival, but the negative consequences of screening will occur immediately. Abnormal screening may trigger additional testing, with attendant anxiety. In particular, the detection of low-risk malignancy would probably result in a recommendation for treatment, which could impair rather than improve quality of life, without improving survival. Despite these considerations, many women with poor life expectancy due to age or health status often undergo screening mammography.[1]

Elderly Women

Screening mammography in women older than 65 years often results in additional diagnostic testing in 85 per 1,000, with cancer diagnosed in nine. The testing is often accomplished over many months, which may cause anxiety due to diagnostic uncertainty.[2] While screening mammography may yield cancer diagnoses in approximately 1% of elderly women, many of these cancers are low risk. A study of California Medicare beneficiaries aged 65 to 79 years demonstrated this clearly. The relative risk (RR) of detecting local Breast Cancer was 3.3 (95% CI, 3.1-3.5) among screened women. Diagnosis of metastatic cancer was reduced among screened women (RR 0.57), suggesting there may be benefit of mammography screening in elderly women, though it comes with an increased risk of overdiagnosis.[3]

Young Women

One study examined the usefulness of mammography in evaluating breast complaints in 1,908 women aged 35 years or younger. Although 23 were found to have palpable cancers, none of the 1,908 mammograms contributed any information that affected patient management.[4]

Women with Thoracic Radiation

Screening has been recommended for women exposed to therapeutic radiation, especially if exposed at young age. Screening mammography and magnetic resonance imaging can identify early-stage cancers, but the benefits and risks have not been clearly defined.

Race

Although age-adjusted breast cancer incidence rates are higher in white women than in black women, mortality rates are higher in black women. Among breast cancer cases diagnosed from 1995 to 2001, 64% of white women and only 53% of black women had localized disease. The 5-year relative survival rate for localized disease was 98.5% for white women and 92.2% for black women; for regional disease, it was 82.9% for white women and 68.3% for black women; and for distant disease, it was 27.7% for white women and 16.3% for black women. Both Breast Cancer incidence and mortality are lower among Hispanic and Asian/Pacific Islander women than among white and black women.[5]