The Risk of Overdiagnosis in Older Women Screened for Breast Cancer

Breast cancer screening has long been established as an essential tool in detecting and treating breast cancer. However, a recent study has shed light on the potential risks of overdiagnosis in older women. The study, conducted by researchers at the Yale School of Medicine, revealed that a significant proportion of breast cancers in women aged 70 and above were potentially overdiagnosed. This article aims to critically analyze the study’s findings and implications while exploring the need for a more comprehensive understanding of breast cancer screening in older women.

The retrospective cohort study found that approximately 31% of breast cancers detected through screening in women aged 70 to 74 could be classified as overdiagnosed. As age increased, the risk of overdiagnosis also rose, with 47% of cases potentially overdiagnosed in women aged 75 to 84 and 54% in women aged 85 years and older. Furthermore, when considering life expectancy, the estimated proportion of overdiagnosed breast cancers differed based on the number of years a woman was expected to live.

Overdiagnosis refers to the detection of a cancer that would not have caused symptoms or harm in a person’s lifetime. It is now recognized as a significant harm associated with breast cancer screening. While screening may provide benefits in terms of early detection and treatment, the potential risks of overdiagnosis cannot be ignored. The study highlights the need for explicit consideration of overdiagnosis when making decisions about breast cancer screening, as the benefits and harms may not be equally balanced for all individuals.

The study’s findings revealed an overall absolute risk of 2% for overdiagnosis after 15 years of screening. However, determining whether this rate is considered high depends on various factors, including the potential benefits of screening. This raises the question of how to weigh the risks and benefits of screening in older women. Patient preferences, such as risk tolerance, comfort with uncertainty, and willingness to undergo treatment, should be taken into account when making informed screening decisions.

In an accompanying editorial, experts highlighted the distinction between discussions of overdiagnosis and the effectiveness of mammography in saving lives. While routine mammography programs have been shown to save lives, there is a need to emphasize the importance of high-quality screening programs. The current messaging surrounding mammography often fails to stress the need for reliable and accurate programs. Objective prognostic markers that can identify indolent types of cancer could potentially spare patients unnecessary treatment.

To address the issue of overdiagnosis, the editorialists suggest that further research into cancer genomics is crucial. A 21st-century definition of breast cancer should take into account not just biopsy and pathological appearance but also genomics. Breast cancer is not a singular entity but a collection of distinct diseases with varying behaviors and treatment requirements. By advancing our understanding of cancer genomics, we can improve the accuracy of diagnoses and tailor treatments accordingly.

The study analyzed data from the SEER-Medicare registry, which included a 5% sample of Medicare fee-for-service beneficiaries. A total of 54,635 women aged 70 and older were included in the analysis. The cumulative incidence of breast cancer was compared between women who continued screening and those who did not. Overdiagnosis was measured by calculating the absolute difference in cumulative breast cancer incidence between the screened and non-screened groups.

The risk of overdiagnosis in older women screened for breast cancer is a significant concern. The study’s findings suggest that a substantial proportion of breast cancers detected through screening in older women may potentially be overdiagnosed. As we continue to refine our understanding of breast cancer screening, it is essential to consider the benefits and potential harms of overdiagnosis. Patient preferences and advancements in cancer genomics should guide screening decisions to ensure optimal outcomes for older women.


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