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Screening at Age Extremes (< 40, > 70 Years)
Amy M. Fowler, MD, PhD
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KEY FACTS

  • Imaging

    • Top Differential Diagnoses

      • Clinical Issues

        TERMINOLOGY

        • Definitions

          • Average risk: 1 in 8 (12%) lifetime risk of breast cancer (across all women)
          • Intermediate risk: 13-19% lifetime risk of breast cancer
          • High risk: ≥ 20-25% lifetime risk of breast cancer

        IMAGING

        • Imaging Recommendations

          DIFFERENTIAL DIAGNOSIS

            PATHOLOGY

            • Microscopic Features

              CLINICAL ISSUES

              • Demographics

                • Natural History & Prognosis

                  • Treatment

                    • Risk Stratification

                      DIAGNOSTIC CHECKLIST

                      • Consider

                        • Image Interpretation Pearls

                          • Reporting Tips

                            Selected References

                            1. Lee CS et al: Screening for breast cancer in women age 75 years and older. AJR Am J Roentgenol. 210(2):256-263, 2018
                            2. Monticciolo DL et al: Breast cancer screening in women at higher-than-average risk: recommendations from the ACR. J Am Coll Radiol. 15(3 Pt A):408-414, 2018
                            3. Expert Panel on Breast Imaging et al: ACR Appropriateness Criteria® breast cancer screening. J Am Coll Radiol. 14(11S):S383-S390, 2017
                            4. Frey MK et al: Multigene panels in Ashkenazi Jewish patients yield high rates of actionable mutations in multiple non-BRCA cancer-associated genes. Gynecol Oncol. 146(1):123-128, 2017
                            5. Ilenko A et al: Could patients older than 75 years benefit from a systematic breast cancer screening program? Anticancer Res. 37(2):903-907, 2017
                            6. Kotwal AA et al: Cancer screening in the elderly: a review of breast, colorectal, lung, and prostate cancer screening. Cancer J. 23(4):246-253, 2017
                            7. Lee CS et al: Association of patient age with outcomes of current-era, large-scale screening mammography: analysis of data from the national mammography database. JAMA Oncol. 3(8):1134-1136, 2017
                            8. Monticciolo DL et al: Breast cancer screening for average-risk women: recommendations from the ACR commission on breast imaging. J Am Coll Radiol. 14(9):1137-1143, 2017
                            9. Massimino KP et al: How beneficial is follow-up mammography in elderly breast cancer survivors? Ann Surg Oncol. 23(11):3518-3523, 2016
                            10. Siu AL et al: Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 164(4):279-96, 2016
                            11. Hartman M et al: Annual screening mammography for breast cancer in women 75 years old or older: to screen or not to screen. AJR Am J Roentgenol. 204(5):1132-6, 2015
                            12. Oeffinger KC et al: Breast cancer screening for women at average risk: 2015 guideline update from the American Cancer Society. JAMA. 314(15):1599-614, 2015
                            13. Vacek PM et al: A prospective study of the use and effects of screening mammography in women aged 70 and older. J Am Geriatr Soc. 63(1):1-7, 2015
                            14. Malmgren JA et al: Improved prognosis of women aged 75 and older with mammography-detected breast cancer. Radiology. 273(3):686-94, 2014
                            15. Schonberg MA et al: Development and evaluation of a decision aid on mammography screening for women 75 years and older. JAMA Intern Med. 174(3):417-24, 2014
                            16. Simon MS et al: Mammography interval and breast cancer mortality in women over the age of 75. Breast Cancer Res Treat. 148(1):187-95, 2014
                            17. Walter LC et al: Screening mammography in older women: a review. JAMA. 311(13):1336-47, 2014
                            18. Berg WA et al: Detection of breast cancer with addition of annual screening ultrasound or a single screening MRI to mammography in women with elevated breast cancer risk. JAMA 307(13):1394-404, 2012
                            19. Le-Petross HT et al: Effectiveness of alternating mammography and magnetic resonance imaging for screening women with deleterious BRCA mutations at high risk of breast cancer. Cancer. 117(17):3900-7, 2011
                            20. Mathieu E et al: Informed choice in mammography screening: a randomized trial of a decision aid for 70-year-old women. Arch Intern Med. 167(19):2039-46, 2007
                            21. Breast cancer screening in older women. American Geriatrics Society Clinical Practice Committee. J Am Geriatr Soc. 48(7):842-4, 2000
                            22. Struewing JP et al: The risk of cancer associated with specific mutations of BRCA1 and BRCA2 among Ashkenazi Jews. N Engl J Med. 336(20):1401-8, 1997
                            Related Anatomy
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                            Related Differential Diagnoses
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                            References
                            Tables

                            Tables

                            KEY FACTS

                            • Imaging

                              • Top Differential Diagnoses

                                • Clinical Issues

                                  TERMINOLOGY

                                  • Definitions

                                    • Average risk: 1 in 8 (12%) lifetime risk of breast cancer (across all women)
                                    • Intermediate risk: 13-19% lifetime risk of breast cancer
                                    • High risk: ≥ 20-25% lifetime risk of breast cancer

                                  IMAGING

                                  • Imaging Recommendations

                                    DIFFERENTIAL DIAGNOSIS

                                      PATHOLOGY

                                      • Microscopic Features

                                        CLINICAL ISSUES

                                        • Demographics

                                          • Natural History & Prognosis

                                            • Treatment

                                              • Risk Stratification

                                                DIAGNOSTIC CHECKLIST

                                                • Consider

                                                  • Image Interpretation Pearls

                                                    • Reporting Tips

                                                      Selected References

                                                      1. Lee CS et al: Screening for breast cancer in women age 75 years and older. AJR Am J Roentgenol. 210(2):256-263, 2018
                                                      2. Monticciolo DL et al: Breast cancer screening in women at higher-than-average risk: recommendations from the ACR. J Am Coll Radiol. 15(3 Pt A):408-414, 2018
                                                      3. Expert Panel on Breast Imaging et al: ACR Appropriateness Criteria® breast cancer screening. J Am Coll Radiol. 14(11S):S383-S390, 2017
                                                      4. Frey MK et al: Multigene panels in Ashkenazi Jewish patients yield high rates of actionable mutations in multiple non-BRCA cancer-associated genes. Gynecol Oncol. 146(1):123-128, 2017
                                                      5. Ilenko A et al: Could patients older than 75 years benefit from a systematic breast cancer screening program? Anticancer Res. 37(2):903-907, 2017
                                                      6. Kotwal AA et al: Cancer screening in the elderly: a review of breast, colorectal, lung, and prostate cancer screening. Cancer J. 23(4):246-253, 2017
                                                      7. Lee CS et al: Association of patient age with outcomes of current-era, large-scale screening mammography: analysis of data from the national mammography database. JAMA Oncol. 3(8):1134-1136, 2017
                                                      8. Monticciolo DL et al: Breast cancer screening for average-risk women: recommendations from the ACR commission on breast imaging. J Am Coll Radiol. 14(9):1137-1143, 2017
                                                      9. Massimino KP et al: How beneficial is follow-up mammography in elderly breast cancer survivors? Ann Surg Oncol. 23(11):3518-3523, 2016
                                                      10. Siu AL et al: Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 164(4):279-96, 2016
                                                      11. Hartman M et al: Annual screening mammography for breast cancer in women 75 years old or older: to screen or not to screen. AJR Am J Roentgenol. 204(5):1132-6, 2015
                                                      12. Oeffinger KC et al: Breast cancer screening for women at average risk: 2015 guideline update from the American Cancer Society. JAMA. 314(15):1599-614, 2015
                                                      13. Vacek PM et al: A prospective study of the use and effects of screening mammography in women aged 70 and older. J Am Geriatr Soc. 63(1):1-7, 2015
                                                      14. Malmgren JA et al: Improved prognosis of women aged 75 and older with mammography-detected breast cancer. Radiology. 273(3):686-94, 2014
                                                      15. Schonberg MA et al: Development and evaluation of a decision aid on mammography screening for women 75 years and older. JAMA Intern Med. 174(3):417-24, 2014
                                                      16. Simon MS et al: Mammography interval and breast cancer mortality in women over the age of 75. Breast Cancer Res Treat. 148(1):187-95, 2014
                                                      17. Walter LC et al: Screening mammography in older women: a review. JAMA. 311(13):1336-47, 2014
                                                      18. Berg WA et al: Detection of breast cancer with addition of annual screening ultrasound or a single screening MRI to mammography in women with elevated breast cancer risk. JAMA 307(13):1394-404, 2012
                                                      19. Le-Petross HT et al: Effectiveness of alternating mammography and magnetic resonance imaging for screening women with deleterious BRCA mutations at high risk of breast cancer. Cancer. 117(17):3900-7, 2011
                                                      20. Mathieu E et al: Informed choice in mammography screening: a randomized trial of a decision aid for 70-year-old women. Arch Intern Med. 167(19):2039-46, 2007
                                                      21. Breast cancer screening in older women. American Geriatrics Society Clinical Practice Committee. J Am Geriatr Soc. 48(7):842-4, 2000
                                                      22. Struewing JP et al: The risk of cancer associated with specific mutations of BRCA1 and BRCA2 among Ashkenazi Jews. N Engl J Med. 336(20):1401-8, 1997