Skip to main content

Mammography use and breast cancer incidence among older U.S. women

A Correction to this article was published on 05 April 2021

This article has been updated

Abstract

Purpose

The death rate for female breast cancer increases progressively with age, but organizations differ in their mammography screening recommendations for older women. To understand current patterns of screening mammography use and breast cancer diagnoses among older women, we examined recent national data on mammography screening use and breast cancer incidence and stage at diagnosis among women aged ≥ 65 years.

Methods

We examined breast cancer incidence using the 2016 United States Cancer Statistics dataset and analyzed screening mammography use among women aged ≥ 65 years using the 2018 National Health Interview Survey.

Results

Women aged 70–74 years had the highest breast cancer incidence rate (458.3 cases per 100,000 women), and women aged ≥ 85 years had the lowest rate (295.2 per 100,000 women). The proportion of cancer diagnosed at distant stage or with unknown stage increased with age. Over half of women aged 80–84 years and 26.0% of women aged ≥ 85 years reported a screening mammogram within the last 2 years. Excellent/very good/good self-reported health status (p = .010) and no dependency in activities of daily living/instrumental activities of daily living (p < .001) were associated with recent mammography screening.

Conclusion

Breast cancer incidence rates and stage at diagnosis vary by age. Many women aged ≥ 75 years receive screening mammograms. The results of this study point to areas for further investigation to promote optimal mammography screening among older women.

This is a preview of subscription content, access via your institution.

Fig. 1

Data availability

All data is free and available online at the links included in the manuscript and references.

Code availability

SAS and SUDAAN code will be made available upon reasonable request.

Change history

References

  1. Nelson HD, Cantor A, Humphrey L, Fu R, Pappas M, Daeges M, Griffin J (2016) Screening for Breast Cancer: A Systematic Review to Update the 2009 U.S. Preventive Services Task Force Recommendation. Ann Intern Med. https://doi.org/10.7326/M15-0970

    Article  PubMed  PubMed Central  Google Scholar 

  2. Centers for Disease Control and Prevention. Breast Cancer Screening Guidelines for Women. https://www.cdc.gov/cancer/breast/pdf/breast-cancer-screening-guidelines-508.pdf

  3. Oeffinger KC, Fontham ET, Etzioni R, Herzig A, Michaelson JS, Shih YC, Walter LC, Church TR, Flowers CR, LaMonte SJ, Wolf AM, DeSantis C, Lortet-Tieulent J, Andrews K, Manassaram-Baptiste D, Saslow D, Smith RA, Brawley OW, Wender R, American Cancer S (2015) Breast Cancer Screening for Women at Average Risk: 2015 Guideline Update From the American Cancer Society. JAMA 314(15):1599–1614. https://doi.org/10.1001/jama.2015.12783

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  4. Monticciolo DL, Newell MS, Hendrick RE, Helvie MA, Moy L, Monsees B, Kopans DB, Eby PR, Sickles EA (2017) Breast Cancer Screening for Average-Risk Women: Recommendations From the ACR Commission on Breast Imaging. J Am Coll Radiol 14(9):1137–1143. https://doi.org/10.1016/j.jacr.2017.06.001

    Article  PubMed  Google Scholar 

  5. Qaseem A, Lin JS, Mustafa RA, Horwitch CA, Wilt TJ, Clinical Guidelines Committee of the American College of P (2019) Screening for Breast Cancer in Average-Risk Women: A Guidance Statement From the American College of Physicians. Ann Intern Med 170(8):547–560. https://doi.org/10.7326/M18-2147

    Article  PubMed  Google Scholar 

  6. Sharma R, Pannikottu J, Xu Y, Tung M, Nothelle S, Oakes AH, Segal JB (2018) Factors Influencing Overuse of Breast Cancer Screening: A Systematic Review. J Womens Health (Larchmt) 27(9):1142–1151. https://doi.org/10.1089/jwh.2017.6689

    Article  Google Scholar 

  7. US Cancer Statistics Working Group U.S. Cancer Statistics Data Visualizations Tool, based on November 2018 submission data (1999–2016): U.S. Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute. Accessed 5 September 2019

  8. National Program of Cancer Registries and Surveillance, Epidemiology, and End Results SEER*Stat Database: NPCR and SEER Incidence – U.S. Cancer Statistics Public Use Research Database, Nov 2018 submission (2001–2016). United States Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute. Released June 2019, based on November 2018 submissions. www.cdc.gov/cancer/public-use.

  9. National Center for Health Statistics (2019) National Health Interview Survey, 2018. Public-use data file and documentation. https://www.cdc.gov/nchs/nhis/data-questionnaires-documentation.htm.

  10. Singh S, Henley S (2013) Ryerson A (2017) Surveillance for Cancer Incidence and Mortality-United States. MMWR Surveill Summ 66(4):1–36

    Article  Google Scholar 

  11. US Cancer Statistics Working Group (2019) United States Cancer Statistics: 1999–2016. Incidence and Mortality Web-Based Report. U.S. Department of Health and Human Services, CDC, National Cancer Institute. https://nccd.cdc.gov/uscs.

  12. National Center for Health Statistics (Hyasttsvile, Maryland. 2019) Survey Description, National Health Interview Survey, 2018.

  13. Dickie LJ, Adams S, Negoita S (2019) Solid Tumor Rules. National Cancer Institute, Rockville, MD

    Google Scholar 

  14. National Program of Cancer Registries (NPCR) and Surveillance Epidemiology & End Results NPCR and SEER Incidence -- US Cancer Statistics 2001–2016 Public Use Database Data Standards and Data Dictionary. www.cdc.gov/cancer/uscs/public-use.

  15. Young JL, Roffers SD, Ries LAG, Fritz AG, Hurlbut AA (2001) SEER Summary Staging Manual - 2000: Codes and Coding Instructions. National Cancer Institute, NIH, Bethesda, MD

    Google Scholar 

  16. Kohler BA, Sherman RL, Howlader N, Jemal A, Ryerson AB, Henry KA, Boscoe FP, Cronin KA, Lake A, Noone AM, Henley SJ, Eheman CR, Anderson RN, Penberthy L (2015) Annual Report to the Nation on the Status of Cancer, 1975–2011, Featuring Incidence of Breast Cancer Subtypes by Race/Ethnicity, Poverty, and State. J Natl Cancer Inst. https://doi.org/10.1093/jnci/djv048

    Article  PubMed  PubMed Central  Google Scholar 

  17. Shoemaker ML, White MC, Wu M, Weir HK, Romieu I (2018) Differences in breast cancer incidence among young women aged 20–49 years by stage and tumor characteristics, age, race, and ethnicity, 2004–2013. Breast Cancer Res Treat 169(3):595–606. https://doi.org/10.1007/s10549-018-4699-9

    Article  PubMed  PubMed Central  Google Scholar 

  18. Schonberg MA, Hamel MB, Davis RB, Griggs MC, Wee CC, Fagerlin A, Marcantonio ER (2014) Development and evaluation of a decision aid on mammography screening for women 75 years and older. JAMA Intern Med 174(3):417–424. https://doi.org/10.1001/jamainternmed.2013.13639

    Article  PubMed  PubMed Central  Google Scholar 

  19. Garcia-Albeniz X, Hernan MA, Logan RW, Price M, Armstrong K, Hsu J (2020) Continuation of Annual Screening Mammography and Breast Cancer Mortality in Women Older Than 70 Years. Ann Intern Med. https://doi.org/10.7326/m18-1199

    Article  PubMed  Google Scholar 

  20. Bahl M, Pinnamaneni N, Mercaldo S, McCarthy AM, Lehman CD (2019) Digital 2D versus Tomosynthesis Screening Mammography among Women Aged 65 and Older in the United States. Radiology 291(3):582–590. https://doi.org/10.1148/radiol.2019181637

    Article  PubMed  Google Scholar 

  21. Fedewa SA, de Moor JS, Ward EM, DeSantis CE, Goding Sauer A, Smith RA, Jemal A (2016) Mammography Use and Physician Recommendation After the 2009 U.S. Preventive Services Task Force Breast Cancer Screening Recommendations. Am J Prev Med 50(5):e123–e131. https://doi.org/10.1016/j.amepre.2015.10.010

    Article  PubMed  Google Scholar 

  22. Torke AM, Schwartz PH, Holtz LR, Montz K, Sachs GA (2013) Older adults and forgoing cancer screening: “I think it would be strange.” JAMA Intern Med 173(7):526–531. https://doi.org/10.1001/jamainternmed.2013.2903

    Article  PubMed  PubMed Central  Google Scholar 

  23. Lee SJ, Boscardin WJ, Stijacic-Cenzer I, Conell-Price J, O’Brien S, Walter LC (2013) Time lag to benefit after screening for breast and colorectal cancer: meta-analysis of survival data from the United States, Sweden, United Kingdom, and Denmark. BMJ (Clinical research ed) 346:e8441. https://doi.org/10.1136/bmj.e8441

    Article  Google Scholar 

  24. Braithwaite D, Demb J, Henderson LM (2016) Optimal breast cancer screening strategies for older women: current perspectives. Clin Interv Aging 11:111–125. https://doi.org/10.2147/CIA.S65304

    Article  PubMed  PubMed Central  Google Scholar 

  25. Schonberg MA, Breslau ES, McCarthy EP (2013) Targeting of mammography screening according to life expectancy in women aged 75 and older. J Am Geriatr Soc 61(3):388–395. https://doi.org/10.1111/jgs.12123

    Article  PubMed  PubMed Central  Google Scholar 

  26. Bynum JP, Braunstein JB, Sharkey P, Haddad K, Wu AW (2005) The influence of health status, age, and race on screening mammography in elderly women. Arch Intern Med 165(18):2083–2088. https://doi.org/10.1001/archinte.165.18.2083

    Article  PubMed  Google Scholar 

  27. McPherson CP, Swenson KK, Lee MW (2002) The effects of mammographic detection and comorbidity on the survival of older women with breast cancer. J Am Geriatr Soc 50(6):1061–1068. https://doi.org/10.1046/j.1532-5415.2002.50261.x

    Article  PubMed  Google Scholar 

  28. Walter LC, Lindquist K, Covinsky KE (2004) Relationship between health status and use of screening mammography and Papanicolaou smears among women older than 70 years of age. Ann Intern Med 140(9):681–688. https://doi.org/10.7326/0003-4819-140-9-200405040-00007

    Article  PubMed  Google Scholar 

  29. Brawley O (2020) On mammography screening for women older than 70 years. Ann Intern Med 172(6):427–428. https://doi.org/10.7326/m20-0429

    Article  PubMed  Google Scholar 

  30. Warner DF, Koroukian SM, Schiltz NK, Smyth KA, Cooper GS, Owusu C, Stange KC, Berger NA (2019) Complex Multimorbidity and Breast Cancer Screening Among Midlife and Older Women: The Role of Perceived Need. Gerontologist 59(Suppl 1):S77–S87. https://doi.org/10.1093/geront/gny180

    Article  PubMed  PubMed Central  Google Scholar 

  31. Schoenborn NL, Huang J, Sheehan OC, Wolff JL, Roth DL, Boyd CM (2019) Influence of Age, Health, and Function on Cancer Screening in Older Adults with Limited Life Expectancy. J Gen Intern Med 34(1):110–117. https://doi.org/10.1007/s11606-018-4717-y

    Article  PubMed  Google Scholar 

  32. Schonberg MA, Kistler CE, Pinheiro A, Jacobson AR, Aliberti GM, Karamourtopoulos M, Hayes M, Neville BA, Lewis CL, Wee CC, Fagerlin A, Nekhlyudov L, Marcantonio ER, Hamel MB, Davis RB (2020) Effect of a Mammography Screening Decision Aid for Women 75 Years and Older: A Cluster Randomized Clinical Trial. JAMA Intern Med. https://doi.org/10.1001/jamainternmed.2020.0440

    Article  PubMed  PubMed Central  Google Scholar 

  33. Craig BM, Quinn GP, Vadaparampil ST (2009) Sensitivity of self-report mammography use in older women. Am J Prev Med 37(5):441–444. https://doi.org/10.1016/j.amepre.2009.07.007

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to thank Jessica King and Zahava Berkowitz for statistical and programming consultation. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention or the National Cancer Institute.

Funding

Dr. Turbow’s work on this project and paper was supported in part by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number D33HP31669 and title “Preventive Medicine Residencies” for $1,936,878. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the U.S. Government.

Author information

Authors and Affiliations

Authors

Contributions

ST: Conception and design, data analysis and interpretation, drafting and revising article, final approval of submitted version. MW: Conception and design, data interpretation, drafting and revising article, final approval of submitted version. EB: Conception and design, data interpretation, drafting and revising article, final approval of submitted version. SS: Conception and design, data analysis and interpretation, drafting and revising article, final approval of submitted version.

Corresponding author

Correspondence to Sara D. Turbow.

Ethics declarations

Conflict of interest

Dr. Turbow has received grant support from Gilead Sciences, Inc. and Merck for research unrelated to this work. No other financial or personal conflicts exist. No other authors reported conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Turbow, S.D., White, M.C., Breslau, E.S. et al. Mammography use and breast cancer incidence among older U.S. women. Breast Cancer Res Treat 188, 307–316 (2021). https://doi.org/10.1007/s10549-021-06160-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-021-06160-4

Keywords

  • Older adults
  • Mammogram
  • Breast cancer
  • Incidence