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A new study published in the Annals of Internal Medicine reports that the overdiagnosis of breast cancer in older women is quite common among those who are diagnosed.
According to Cancer Research UK, the term “overdiagnosis” refers to cancer that would most likely not have caused any symptoms during the remainder of the person’s lifetime; and, if that person had never been screened, they would never have become aware that they had it.
Overdiagnosis is a problem, the organization explains, because it causes people to go through arduous treatments and the accompanying emotional distress unnecessarily.
In fact, the study found that among a population of over 50,000 women, continued breast cancer screening after the age of 70 was linked to a greater incidence of cancer that would not have caused symptoms in the person’s/patient’s lifetime.
Currently, the screening guidelines for women in this age group vary due to the fact that it is unclear whether the harms of screening outweigh any benefits.
In addition to the risk of overdiagnosis, the authors write that false positives are a potential harm in older women because they lead to unnecessary worry, testing, and procedures.
False positives, in contrast with overdiagnosis, occur when people are thought to be at higher risk for cancer when actually their risk is normal.
Breast cancer overdiagnosis is common for women over 70
The researchers studied a group including 54,635 women who were aged 70 and older. All participants had been screened for breast cancer in the recent past.
Upon analysis of the data, they found that the risk for overdiagnosis grew as women got older.
Among women aged 70 to 74, they estimated that 31% of breast cancer was overdiagnosed.
Between the ages of 74 to 84, this figure rose to 47%.
And, in those aged 85 and older, it rose even further to 54%.
However, the researchers said, they did not see meaningful reductions in deaths from breast cancer as a result of these screenings.
They state that the possibility of overdiagnosis should be factored in when deciding whether to screen older women and balanced with any potential benefits to be gained.
Dr. Ilana Richman, the lead author of the study, noted, however, that only about 2% of older women who continued to receive screening for breast cancer will be overdiagnosed.
“So if women continue screening, overdiagnosis is actually not incredibly common overall,” she stated.
However, among those who do end up being diagnosed, between 31% and 63% may be overdiagnosed, depending on their age and how long they live.
“So among women who are screened and diagnosed with breast cancer, overdiagnosis is pretty common,” said Richman.
What are the risks associated with overdiagnosis?
Christine Kingsley, an Advanced Practice Registered Nurse (APRN) and the Health and Wellness Director of the Lung Institute, said that overdiagnosis is “incredibly harmful to a patient.”
She noted that there are behavioral and psychological impacts for the person receiving this label.
Additionally, it leads to all of the burdens of overtreatment, she said.
“Exposing a patient to unnecessary treatments and therapies is often dangerous and there’s no benefit to it. In the case of breast cancer overdiagnosis, the benefits don’t necessarily outweigh the risks, as the treatment will always be tailored to the intensity of the cancer.”
Kingsley explained that when a tumor is found that appears to be high risk, this triggers a particular path of treatment, including biopsies, surgeries, chemotherapy, and radiation.
“These things can be especially harmful if said tumor isn’t supposed to be deadly and progressive,” said Kingsley.
“Invasive treatments, especially, can be risky and can lead to financial and psychological distress,” she concluded.
What do these findings mean for older women?
According to Richman, the main thing to take away from this study is that screenings really need to be tailored to each person’s needs.
“For older women who are in good health and maybe in their early or mid-70s, the risk of overdiagnosis may be acceptable,” she said. “For women getting into their 80s or who have a lot of other serious health conditions, the risk of overdiagnosis is higher and may begin to outweigh benefits of screening.”
What to consider before deciding on screening
Dr. Sridhar Papaiah Susheela, a radiation oncologist at ClinicSpots, said, “Regardless of your age, it is important to talk to your doctor about the best screening plan for you.
“They will be able to review your health history and make personalized recommendations on when to start and how often you should get screenings,” he explained.
Susheela noted that it’s important to weigh the risks and benefits of routine breast cancer screening before making your decision.
Understanding overdiagnosis is one factor in this process as well as knowing the guidelines for when to start and how often to get screenings.
Susheela said the American Cancer Society advises starting mammograms before the age of 40 if you are high risk. Risk factors include family history, dense breasts, and genetics, he explained. Talking with your doctor can help clarify whether you need to begin screening early.
As far as frequency of screening, Susheela said that women 40 and older should get a mammogram every year or two, depending on their own needs.
Women who are at higher risk would need to be screened more often.
Again, he emphasized, it’s important to speak with your doctor to determine what is best for your individual case.
“With the right knowledge and guidance, you can make an informed choice about preventive screenings that are best for you,” said Susheela.