Odds Good for Older Women With DCIS, Early Breast Cancer

By Charles Bankhead, Staff Writer, MedPage Today

A diagnosis of ductal carcinoma in-situ (DCIS) or stage I breast cancer does not reduce survival odds for women older than 67, but diagnosis of a higher-stage malignancy does, an NIH database analysis showed.

Women with DCIS or stage I breast cancer had mortality hazards of 0.9 to 1.0 compared with age-matched women who did not have breast cancer, according to Mara A. Schonberg, MD, of Beth Israel Deaconess Medical Center in Boston, and colleagues.

However, the mortality risk increased by 50% compared with controls with a diagnosis of stage II or higher breast cancer, they reported online in the Journal of Clinical Oncology.

"More women age 67 years and older diagnosed with DCIS or stage I breast cancer and women age ≥80 years diagnosed with stage II disease die of cardiovascular disease than breast cancer," Schonberg and colleagues wrote in the discussion of their findings.
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Lessons from the Mammography Wars | Health Policy and Reform

by Kerianne H. Quanstrum, M.D., Rodney A. Hayward, M.D.

The controversy was predictable.

Since 2002, annual mammograms had been recommended for women 40 years of age or older.² Suddenly, an independent, government-funded panel was suggesting that this schedule might be too much — that less, in fact, might be better.

Advocates of breast-cancer screening, particularly breast radiologists, immediately took action, denouncing the panel’s statements as government rationing, suggesting that the panel members had ignored the medical evidence, and even implying that the panel members were guilty of a callous disregard for the life and well-being of women. As one prominent breast radiologist put it, “Basically, [the panel] said nothing is good. Just wait until it breaks through your skin. . . .”³ Specialty societies quickly issued countermanding guidelines.⁴

In reality, this independent panel, the Preventive Services Task Force, simply recommended that routine screening mammography begin at the age of 50 years, whereas women between the ages of 40 and 49 years should make individual decisions with their doctors as to whether their preferences and risk factors indicate screening at an earlier age. The panel also recommended that screening mammograms be performed every other year, which they suggested would reduce the harms of mammography by nearly half while maintaining most of the benefits provided by annual imaging.⁵ In short, the panel concluded that we had previously overestimated the value of mammography: that mammography is good, but not that good; that it is necessary for many women, but not all; and that it should be performed at some frequency, but perhaps not every year, for every woman.

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