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Submission To Be Reviewed

Title:  What about extension of the target-age range of mammography screening program in women over 70? An Italian experience in Piedmont (Northern Italy).

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BACKGROUND: Breast cancer is a major cause of cancer-related deaths among older women, aged 65 years or older. Age is the major risk factor for developing and dying from breast cancer. Screening mammography has been shown to be effective in reducing breast cancer mortality in women aged 50–69; few studies include women over the age of 70. In some Italian regions (as in Piedmont in the North of Italy), the extension of organized screening to women 70-75 years began in 2010.

OBJECTIVE: To evaluate the benefits of mammography screening in older women (aged over 70 years) in order to properly inform women and take a correct approach for decision-making about screening cessation.

MATERIALS AND METHODS: We analyze an Italian experience in Piedmont. Considering the screening mammograms carried out from 1 September 2010 to the end of 2018 in one of the six local programs, we extrapolated, in the specific age sub-group of women over 70 years, the diagnostic indicators values of specificity (such as the recall rate) and of sensitivity (such as the total detection rate, the benign to malignant ratio, the proportion of in situ carcinomas, the detection rate of invasive cancers and the detection rate of invasive cancers less than 10 mm of diameter).

RESULTS: Considering a volume of activity of 7986 mammograms performed in women aged over 70 years and  9-year follow-up, the recall rate was 9.31% (as crude value) and 7.70 % (as standardized value).Total detection rate was 32,21 (x 1000 screened). While a benign to malignant ratio of 0,034 and a proportion of in situ carcinomas of 16,25% were recorded. 

In the specific age sub-group of women over 70 years, we obtained an overall average detection rate of invasive tumors of 26,74 (x1,000 screened), a detection rate of the invasive cancers ≤10 mm of 4,08 (x1,000 screened) and a detection rate of carcinoma in situ of 5,47 (x1,000 screened), for the entire period.

CONCLUSIONS AND RELEVANCE: The diagnostic indicators of our study, evaluated in a 9-year follow-up, confirm the effectiveness of organized screening also in the subgroup of women aged 70-75. However, diminished life expectancy with aging may decrease the potential screening benefit and increase the risk of harms as overdiagnosis and overtreatment. As reported in the literature, for women aged over 75 years, with less than a 10-year life expectancy, recommendations to stop organized screening mammography should be to emphasize considering the increase of potential harms from screening. 

Key words: 

aging, breast cancer, screening mammography, Italy

Review Schedule

Editor's request 20-05-2019

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