Table 1 Summary of included studies.
From: Health benefits and harms of mammography screening in older women (75+ years)—a systematic review
Study Reference | Country | Participant population/age of women included | Study design | Screening context/setting | Screening process/screening interval | Comparison made | Total numbers in comparison groups | Follow-up/collection period | Risk of Biasa |
---|---|---|---|---|---|---|---|---|---|
Advani [16] | USA | 66–94 years | Cohort study | Women who underwent screening mammography in 1999–2010 in a Medicare-linked BCSC database. Outcomes ascertained via linkage with regional SEER programmes or state tumour registries | At least one screening mammogram | 66–74 vs 75–84 vs 85–94 | 304,334 vs 190,180 vs 30,346 | Follow-up: Within one year or until next screen Collection period: 1999–2010 | Serious |
Arleo [17] | USA | Using Cancer Intervention and Surveillance Modelling Network (CISNET) to develop models | Modelling study | Using CISNET models to simulate and compare three screening mammography recommendations | Annual and biennial 75–79 years and 75–84 years | Different screening recommendations | 1000 women screened | N/A | Low |
Bennett [18] | England | All women self-referred to NHS screening programme 71 years and older | Screening evaluation study | Analysed data for all women in England over the age of 70 who self-referred in the 2-year period 2005–2008. | All women self-referred to NHS screening programme and attended one screen during the collection period | 70–74 vs 75 and older | 71–74: 86,743, 75+: 53,167 | No follow-up Collection period:3 years (2005–2008) | Serious |
Boer [19] | The Netherlands | MISCAN (Micro Simulation Screening Analysis) model starts with women aged 40, but paper focuses on 70 years and older | Modelling study | The MISCAN model (simulated model with 2-yearly screening carried out during a period of 27 years) | 2-year interval | Optimistic variant vs pessimistic variant and 69 vs 99 | Assuming 100% attendance rate; and realistic attendance and invitation starting at 51 years | N/A | High |
Braithwaite [21] | USA | 66–89 years | Cohort study | Data linkage, registries, women receiving (free) mammograms between 1999 and 2006 | Annual (9–18 months) or biennial (>18–30 months) | 66–74 vs 75–89 | 2993 women aged ≥66 and with breast cancer and 137949 women aged ≥66 and without breast cancer | Follow Up: Not stated, max of 7 years (1999–2006) Collection period: 1999–2006 | Serious |
Braithwaite [20] | USA | 66–99 years | Cross-sectional study | Not reported | At least one screening mammogram | 66–74 vs 75–84 vs 85-99 | 6587 (1.2%) were followed by biopsy within 90 days among 537254 screens (171,636 women). | No follow-up Collection period:1999–2010 | Critical |
Cate [22] | USA | 75 years and older | Cross-sectional descriptive | Screening mammography | Not reported | No comparison | 2057 in total | No follow-up Collection period:2013–2014 | Critical |
Demb [23] | USA | 66–94 years | Cohort study | No less than 1 screening mammogram between 66 and 94 years | All women self-referred to screening NHS programme | 66–74 vs 75–84 vs 85–94 | 222,088 in total | Follow-up: Median of 107 months (IQR = 65–120); Collection period: 1999–2010 | Serious |
Destounis [24] | USA | 75 years and older | Cross-sectional descriptive | Data from 763,256 screening mammograms at Elizabeth Wende Breast Care (all ages) | Mammography but no further details. | No comparison | 76,885 screening participants aged 75+ | No follow-up Collection period: 10 years 2007–2017 | Critical |
El-Zaemey [4] | Australia | 65 years and older | Cohort study | Free screening for all women ≥40 years offered every 2 years | All women aged up to 75 years are invited to participate in biennial screening programme. Women age 75years and older are self-referred. | 65–69 vs 70–74 vs 75 and older | 39,886 vs 26,432 vs 8763 (number of screens) | Follow-up: Up to 3 years Collection period: 2015–2017 | Serious |
Erbas [25] | Australia | 40 years and older | Cross-sectional study | Free screening for all women ≥40 years offered every 2 years | A second or subsequent screen in a woman with at least one prior negative screen within the biennial programme. | 40–49 vs 50–69 vs 70–74 vs 75 and older | 27,661 vs 506,117 vs 87,545 vs 24,699 (646,022 in total) | No follow-up Collection period: 1993–2000 | Serious |
Garcia-Albaniz 2020 | USA | 70–84 years | Cohort study | 20% of Medicare fee for service beneficiaries. No history of BC, continuous enrolment in Medicare Parts A and B for 12+ months | Stop screening (women who do not have any screening after baseline), Continue screening (women who continue annual screening (with 3 mth grace period) | Continue vs stop screening | 1,403,735 (aged 75–84) | Follow-up: Median of 16 months (IQR = 14–32); Collection period: 1999–2008 | Serious |
Hartman [27] | USA | 75 years and older | Cross-sectional descriptive | All screening mammograms performed at institution from 2007 to 2013, outcome is screen detected cancers at institution, free screening for all women annually | Annual breast cancer screening | No comparison | 4424 in total | No follow-up Collection period: 2 February 2007–31 December 2013 | Critical |
Jansen [28] | The Netherlands | A computer model for the simulation of breast cancer screening (MBS) to calculate results of screening in terms of lifetime ≥20 years | Modelling study | The MBS model (simulated model with a stable Swedish population of one million women) | Annual mammography with single view | No comparison | One million | Lifetime (simulated) | Moderate |
Jansen [29] | Sweden | A computer model for the simulation of breast cancer screening (MBS) to calculate results of screening in terms of lifetime ≥20 years | Modelling study | Using Swedish two county study and the MBS model | Annual mammography with single view | No comparison | One million | Lifetime (simulated) | Moderate |
Kregting [30] | The Netherlands | 40-84 years | Modelling study | 920 breast screening strategies with varying starting ages (40–60) and stopping ages (64–84) | Screening intervals of 1-4 years | Many - have chosen annual screening 40-75 to annual screening 40-84 | N/A | N/A | Moderate |
Lansdorp-Vogelaar [31] | USA | US cohorts 66–90 years in 2010 with average health or one of four comorbidity levels - none, mild, moderate, or severe. Using models from CISNET | Modelling study | Simulated data. Assuming all undergo regular screening starting at 50 with biennial mammography and follow individuals for their remaining lifetime. MISCAN-Fadia (Microsimulation screening analysis – Fatal diameter) model and a G-E (Georgetown-Einstein) model | Regular screening starting at age 50 with biennial mammography | 74 vs 76 | Not reported | Lifetime (simulated) | Low |
Malmgren [32] | USA | All women with primary breast cancer aged 50+ (75–94 years) | Cohort study | Cancer detected between 1990 and 2008, presenting at clinic. All women either patient, physician or mammography detected | Mammography but no further details | Mammography detected v physician detected v patient detected | 5595 in total, 75+ = 950 | Follow-up: not stated Collection period:1990–2008 | Serious |
Malmgren [33] | USA | All women with primary breast cancer aged 50+ (75–94 years) | Cohort study | Cancer detected between 1990–2011, presenting at clinic (using registry database). All women either patient, physician or mammography detected | Mammography but no further details | Mammography detected v physician detected v patient detected | 1162 | Follow-up: Mean 7.9 years (range 1.8–21 years) Collection period: 1990–2011 | Serious |
Mandelblatt [34] | USA | Using Cancer Intervention and Surveillance Modelling Network (CISNET) to simulate six models for women born in 1960 beginning at 25 yrs old | Modelling study | Using CISNET models to estimate the benefits and harms of alternate screening strategies | 10 strategies each evaluated using annual and biennial schedule—a total of 20 strategies | Stopping screening | 1000 women screened | N/A | Moderate |
McCarthy [35] | USA | All women in the SEER database wo received a diagnosis of incident breast cancer in 1995 or 1996 and were linked with Medicare data. Aged 69 years and older | Cohort study | Cancer detected between 1987 and 1993 linked to Medicare records which indicated pattern of screening | Non-user (none in past 2 years), single user (once in the last 2 years), regular user (at least 2 screening mammograms at least 11 months apart in past 2 years) | i) Age at diagnosis ii) Non-users v regular users | 67–74 n = 4609 75–84 n = 4072 85+ n = 1086 Screen-usage 67-74: Reg 29%; Non 18% 75–84: Reg 23%; Non 21% 85+: Reg 10%; Non 33% | Follow-up: 1–8 years Collection period: 1987–1993 | Serious |
McPherson [36] | USA | Caucasian women aged 65–101 diagnosed with invasive breast cancer from 1986 to 1994 | Cohort study | Cancer detected between 1986 and 1994 identified from records in the Upper Midwest Oncology Registry System. Method of detection extracted | Mammography but no further details | Mammography detected v clinically detected cancers | 75–79: 599 v 546; 80–84: 473 v 313; 85+: 451 v 148 | Follow-up: not stated, but reports 8–9 years post diagnosis data Collection period: 1986–1994 | Serious |
Park [37] | USA | 40–85 years at baseline | Cohort study | Women enroled in the California Teachers study (1995–1996) followed up with data linkage up until Dec 31 2015 | Routine screening | Never/less frequent v biennial v annual screening | 8024 women aged 75-85 at baseline | Follow-up: 20 years Collection period: 1995–2015 | Serious |
Randolph [38] | USA | All women in the SEER database wo received a diagnosis of incident breast cancer in 1995 or 1996 and were linked with Medicare data. Aged 69 years and older | Cross-sectional study | Cancer detected between 1995 and 1996 linked to Medicare records which indicated pattern of screening | Nonuser (no screening in past 2 years), single user (once in the last 2 years), regular user (at least 2 screening mammograms at least 11 months apart in past 2 years) | 65–74 v 75 and older | Total 11,039. 75+ = 6813 65–74 = 4226 | No follow-up Collection period: 1995–1996 | Serious |
Richman [50] | USA | Women in the SEER database who had not received a diagnosis of breast cancer before 2002, but had had a screening mammogram in 2002 and were linked with Medicare data. Aged 70 years and older | Cohort study | Population setting, screening mammography and breast cancer diagnosis recorded via population data sets (Medicare and SEER database) | Screening mammograms identified in Medicare claims. Initial screen in 2002, subsequent screen in the 3 year period after 2002 screen | Subsequent screen v no subsequent screen (75–84 years) | 23,613 screened, 5707 unscreened | Follow-up: Median 10 years (IQR 5.8–13.9 years) Collection period: 2002–2017 | Moderate |
Schousboe [39] | USA | 65–90 years | Modelling study | Markov modelling using SEER data from 2011 to 2016 | Biennial | Stopping screening at 75 compared to 80, 85 and 90 - by CCS, biennial mammography | N/A | N/A | Moderate |
Simon [40] | USA | Women’s Health Initiative study—75 years and older | Cohort study | Women in WHI diagnosed with breast cancer | Mammography but no further details | Mammography interval - <2 years, 2–5 years, 5+ years or none | 8663 in total - not stated for 75+ | Follow-up: average of 12.2 years Collection period: Not stated (WHI study) | Serious |
Simon [41] | USA | Women’s Health Imitative study—aged 50–79, post-menopausal, (75 years and older) | Cohort study | Women diagnosed with invasive breast cancer at 75 years and older. Followed up until last document contact, death or September 2010 which ever came first | Clinical trials - Annual or biannual, Observational: at the discretion of the individual | Mammography interval - <2years, 2–5 years, 5+ years or none | Total 1914: <2 years = 1398, 2-5 years = 372 5+ years = 144 | Follow-up: mean 4.4 years, max 15.3 years Collection period: Recruitment 1993–1998, Follow-up to 2010 | Serious |
Smith-Bindman [42] | USA | All women with Medicare | Cohort study | Linked data from Medicare screening services and State cancer registry | Any screening within 1992 and 1993 | No screening | Total N = 201,537 (75–79 years), screened n = 201,537 (40%) | Follow-up: 12-24 months Collection period: 1992–1993 | Serious |
Upneja [43] | USA | 67–74 years | Cohort study | SEER database— women who were screened during 2015 | One screening mammogram in 2015 | 67–74 vs 75 and older (all undergoing 2D mammography) | 364,254 vs 230,685 | Follow-up: 4 months Collection period: 2015–2016 | Serious |
VanDijck [44] | The Netherlands | Women invited to screening at least twice, with most recent invitation having occurred over 65 years old | Case control study | Population based screening programme | Women invited to biennial single-view mammography screening. At least 2 mammography screening invitations one of which occurred when the woman is aged 65 years or older | Attended last screen or not | 33 cases, 165 referents - from 65 years older - Based on Table 2: 12 cases (and 12*5 = 60 referents) | Follow-up: NA Collection period: cases had died of breast cancer between 1977 and 1988. | Serious |
VanDijck [45] | The Netherlands | Nijmegen programme: women invited to screening at least twice, with most recent invitation having occurred over 65 years old | Cohort study | Primary breast cancer patients diagnosed before Dec 1994 aged 50+ | Women invited to biennial single-view mammography screening. Women aged 70 years and older invited from 9th screening round onwards | First screen, repeat screen, interval CA or non-participant | 4253 invited to first screen and 33,949 invited to subsequent screens | Follow-up: 2 years (for older ages) Collection period: 1975–1994 | Serious |
VanDijck [46] | The Netherlands | Nijmegen programme: women invited to screening at least twice, with most recent invitation having occurred over 65 years old. Cases died of breast cancer before Jan 1, 1994 | Case control study | Population based screening programme, | Women invited to biennial single-view mammography screening. Women aged 70 years and older invited from 9th screening round onwards | No screening (no participation in index round and 4 preceding rounds) Regular screening (participation in index round and negative mammogram in preceding round) Otherwise (not meeting the criteria for unscreened or screened) | Aged 64+: 82 cases, 410 controls aged 75+: 35 cases, 175 controls - no screening 20/97 - regular screening 3/14 - otherwise 12/64 | Follow-up: NA Collection period: 1975-1994 | Serious |
vanRavesteyn [46] | USA | Simulation of a cohort of American women born in 1960, starting screening 50 | Modelling study | Simulation | All women received biennial screening starting at 50, with cessation ages varying from 74 up to 96 years | Stopping screening at 74 v continuing screening | N/A as this is statistical modelling | N/A | Low |
Vyas [48] | USA | 39,006 women aged 70+ with incident BC from 2005 to 2009 | Retrospective cohort study | From the Surveillance, Epidemiology and End Results (SEER) Medicare dataset. Programme collects information on newly diagnosed cancer cases from 18 population-based tumour registry’s and covers approx. 26% of the US population. | Mammography screening persistence during the 5 years period before BC diagnosis was to be determined, women who were continuously enroled in Medicare parts A/B for at least 60 months before BC diagnosis, and who were not enroled in health maintenance organisations. Persistent users represented a population who have had annual to biennial mammography screening before BC diagnosis | 70–74 v 75–79 v 80 and older | All: 70–74: 12163, 75–79: 11,182, 80+: 15,661. Persistent: 70–74: 6504 75–79: 5672, 80+: 5732 Non-Persistent: 70–74: 3270 75–79: 3019, 80+: 3933 Non-users: 70–74: 2389 75–79: 2491, 80+: 5996 | Follow-up: up to 5 years (at least 60 months) Collection period: Incident BC between 2005–2009, and 5 years prior for screening | Serious |
Yang [49] | USA | Population data women aged 40 years and older | Cohort study | Pre-1977 historical cohort as America initiated screening in 1977. BC diagnosed in 1999 represents the screening cohort— using SEER data | Mammography according to the ACS guidelines at the time for the age group. Population screening in USA— data from SEER data. | 1973–1976 cohort vs 1999 cohort (No screening vs screening) | Total N: 10,538 5708 vs 4830 | Follow-up: 15 years for survival Collection period: year of diagnosis: 1973–1999 | Moderate |