From the Department of Radiology, NYU Langone Health, New York, NY (C.S.L., A.L., B.R., L.H., Y.G., S.H., L.M.); and Center for Advanced Imaging Innovation and Research, Vilcek Institute of Graduate Biomedical Sciences, New York, NY (L.M.).
Radiographics. 2023 May;43(5):e220166. doi: 10.1148/rg.220166.
Breast cancer is the most common cancer in women, with the incidence rising substantially with age. Older women are a vulnerable population at increased risk of developing and dying from breast cancer. However, women aged 75 years and older were excluded from all randomized controlled screening trials, so the best available data regarding screening benefits and risks in this age group are from observational studies and modeling predictions. Benefits of screening in older women are the same as those in younger women: early detection of smaller lower-stage cancers, resulting in less invasive treatment and lower morbidity and mortality. Mammography performs significantly better in older women with higher sensitivity, specificity, cancer detection rate, and positive predictive values, accompanied by lower recall rates and false positives. The overdiagnosis rate is low, with benefits outweighing risks until age 90 years. Although there are conflicting national and international guidelines about whether to continue screening mammography in women beyond age 74 years, clinicians can use shared decision making to help women make decisions about screening and fully engage them in the screening process. For women aged 75 years and older in good health, continuing annual screening mammography will save the most lives. An informed discussion of the benefits and risks of screening mammography in older women needs to include each woman's individual values, overall health status, and comorbidities. This article will review the benefits, risks, and controversies surrounding screening mammography in women 75 years old and older and compare the current recommendations for screening this population from national and international professional organizations. RSNA, 2023 Quiz questions for this article are available through the Online Learning Center.
乳腺癌是女性最常见的癌症，发病率随年龄增长显著上升。老年女性是一个脆弱的群体，患乳腺癌和死于乳腺癌的风险增加。然而，所有随机对照筛查试验都排除了 75 岁及以上的女性，因此，关于该年龄组筛查的益处和风险的最佳现有数据来自观察性研究和模型预测。筛查对老年女性的益处与对年轻女性的益处相同：早期发现较小的低期癌症，从而进行侵袭性较小的治疗，降低发病率和死亡率。在老年女性中，乳房 X 线摄影的表现明显更好，具有更高的灵敏度、特异性、癌症检出率和阳性预测值，同时召回率和假阳性率较低。过度诊断率较低，收益大于风险，直至 90 岁。尽管关于是否应继续对 74 岁以上女性进行乳房 X 线筛查存在国家和国际指南冲突，但临床医生可以使用共同决策来帮助女性做出筛查决策，并让她们充分参与筛查过程。对于身体健康的 75 岁及以上女性，继续每年进行乳房 X 线筛查将挽救最多生命。在讨论对老年女性进行乳房 X 线筛查的益处和风险时，需要包括每位女性的个人价值观、整体健康状况和合并症。本文将回顾 75 岁及以上女性乳房 X 线筛查的益处、风险和争议，并比较来自国家和国际专业组织的该人群筛查建议。RSNA，2023 本文的测验问题可通过在线学习中心获取。
