The 65+ Woman’s Guide to Breast Cancer Screenings

Breast cancer can develop at any age. Does that mean you need to keep getting mammograms for the rest of your life? Here's what to know.

If we’re being honest, many of us have become experts at postponing mammograms.

We know they’re essential. After all, breast cancer is the second-most common cancer in American women. It’s also the second deadliest after lung cancer, according to the American Cancer Society (ACS).

And yet, when you feel healthy and energetic, it’s natural to wonder: Could I put this off for a few more months? Or even a year? It won’t matter too much… will it?

Let’s clear this up: “Screening is for people who don’t have any signs or symptoms of breast cancer — people who are asymptomatic,” says Robert Smith, Ph.D., senior vice president of early detection science for the American Cancer Society. “The fact is, when you don’t have any sense that there is a problem is exactly when we want to find that breast cancer — before it becomes a problem for you.”

So, keep reading, and then do yourself a favor: Get your next mammo on the calendar.

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Breast Cancer, Explained

Breast cancer often begins in the ducts or lobules of the breast. Depending on the type of cancer, it can then spread into other parts of the breast and eventually through blood and lymph vessels to other organs and tissues in the body.

The many types of breast cancer are classified by their location (in a duct, lobe, or lining of a duct), as well as how quickly they grow and spread, says Ruth Etzioni, Ph.D., professor of public health sciences at the Fred Hutchinson Cancer Center. Some of the main types include:

Ductal carcinoma in situ (DCIS): Found in the lining of the breast ducts, in situ cancers have not spread to other tissues.

Invasive ductal carcinoma: These cancers start in the breast ducts and invade other parts of the breast.

Invasive lobular carcinoma: Lobular cancers begin in the breast lobes before spreading to other breast tissue.

The Benefits of Breast Cancer Screening

Lifestyle changes — weight loss, exercise, and abstaining from alcohol — can help prevent about 30% of breast cancers. For the rest, Dr. Smith says regular screenings offer your best chance of catching cancer in its earliest stages, when it’s most treatable.

Deaths from breast cancer have dropped 43% in the past 30 years, which researchers attribute to increased use of mammography.

Recommended reading: 5 Sneaky Signs of Breast Cancer

How Often to Screen

The American Cancer Society recommends women ages 55 and older get a mammogram every other year. After age 74, leading health organizations disagree about the importance of mammograms.

For example, the United States Preventative Services Task Force (USPSTF) doesn't recommend screening for women older than 74. This may sound a bit morbid, but the thinking is that women aged 75 and older will likely die from another disease (such as heart disease) before they will die from undetected breast cancer, says Dr. Etzioni.

The American Cancer Society, however, offers a more nuanced recommendation: Stop screening when you are no longer expected to live another ten years.

“When your chance of dying from something else is so much greater than your chance of developing breast cancer, then you may decide to forgo the screening because it’s probably not going to extend your life,” says Dr. Etzioni.

For the average woman, that tipping point often comes around age 79 or 80, but it depends on her overall health, notes Dr. Smith.

“A lot of very healthy women will continue to benefit from breast cancer screening at age 75, and they should continue to get it,” he adds.

Types of Breast Cancer Screening

Of the many types of screening, mammograms are the gold standard, says Dr. Smith. But there are other types of breast cancer screening to consider. Here's a rundown of your options.

Mammograms

These low-dose X-rays take pictures of the inside of your breasts, spotting tumors you can't see or feel. "If you wait until you find a lump, there's a good chance that the cancer has become advanced, and your treatment will become more aggressive," says Dr. Smith.

There are two main types of mammography.

• 2-dimensional mammography: Here, pictures of the breasts are taken from two different angles.
• Digital breast tomosynthesis (DBT): Sometimes referred to as 3-D mammograms, this newer technology takes pictures of the breasts from many angles. First approved by the FDA in 2018, 3-D mammograms are now offered by most facilities, but not all insurance companies cover the extra cost. DBT provides a clearer picture of the breasts than traditional mammography, resulting in a higher cancer detection rate, according to research.

Magnetic resonance imaging (MRI)

An MRI uses magnets and radio waves to take pictures of the inside of your body. Healthcare providers reserve this screening tool for women at high risk of getting breast cancer, using it in addition to mammography.

To determine your risk level, your healthcare provider will look at your age, family history, and other factors. You may be at high risk if:

• You carry the BRCA1 or BRCA2 genes
• You have a first-degree relative (mother, daughter, sister) who was diagnosed with breast cancer
• You’ve been diagnosed with Li-Fraumeni or Cowden syndrome
• You had radiation done to your chest between the ages of 10 and 30

Ultrasound

This test uses sound waves to generate a computerized picture of the insides of your breasts. It's often used alongside mammography, especially in women with dense breasts.

Breast Self-Exams

You may be surprised that experts no longer encourage breast self-exams. "For many years, we recommended physical exams of the breast because we didn't have mammography," says Dr. Smith.

However, your biannual mammography screening can detect cancer much earlier than your monthly self-exam, he explains. Plus, women tend to find suspicious lumps and changes on their own without doing official self-exams, Dr. Smith says.

"You can, of course, do a breast self-exam - and your doctor will show you how," he continues. "It's okay to do them regularly or occasionally or not at all."

What is most important: If you notice a change in your breasts, see your doctor as soon as possible.

Thermography (Not a Substitute for Mammograms)

Advertisements for thermography certainly sound appealing. Because cancer cells grow and multiply quickly, they can generate more blood flow, causing skin temperature to rise. Thermograms use an infrared-detecting camera to measure breast skin temperature. The test is often marketed as a “safe and comfortable” radiation-free alternative to a mammogram.

It's not. "Not all cancers are hot, and not all things that are hot are cancer. There's been no large study that shows these tests come remotely close to the mammogram," says Dr. Smith. "Thermography is unproven, and women shouldn't get it."

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What to Do if Screening Finds a Mass

An abnormal test result doesn't necessarily mean you have a problematic cancer that requires intense treatment, says Dr. Etzioni. In fact, mammograms often find breast changes that are benign, which meaning they aren't cancerous.

Even if the results do show cancer, the immediate next step might not be treatment. About 22% of cancers diagnosed in women over age 65 probably don’t need to be treated, at least not right away, found a 2022 study of 35,986 women published in the Annals of Internal Medicine.

"The fact is that cancer is not just one thing," says Dr. Etzioni, one of the study authors. "There are many types. Some are more aggressive, while others are slow-growing. The characteristics of the cancer and the person's characteristics - how healthy they are, whether they have other life-threatening health conditions - both matter."

If you get diagnosed with breast cancer, you’ll want to ask some questions, suggests Dr. Etzioni.

• Is it a non-invasive or an invasive cancer?
• What type of cancer is it? For example, is it an aggressive HER2-positive cancer?
• What stage is it? For example, is it localized to only the breast? Or has it spread to other tissues?

You and your doctor will then weigh that information against your age and personal health, says Dr. Etzioni.

For example, say you're in your mid-80s and have already been diagnosed with advanced congestive heart failure. If a screening catches a slow-growing, non-invasive in situ breast cancer, you and your doctor might decide to simply monitor the cancer over time.

On the other hand, let's imagine someone in their mid-60s and in good health other than mildly elevated blood pressure and cholesterol levels. If diagnosed with an invasive type of cancer, they would probably choose an aggressive course of treatment, says Dr. Etzioni.

The bottom line: Your age and current health status factor into whether you still need to get mammograms. Unsure? Your doctor is always there to help guide you.

See our sources:
Breast cancer screening methods: American Cancer Society
Breast cancer overview: Centers for Disease Control and Prevention
Screening recommendations: American Cancer Society
Breast MRI overview: American Cancer Institute
Breast ultrasound overview: American Cancer Institute
Thermogram risks: U.S. Food and Drug Administration
Benign breast changes and mammograms: National Cancer Institute
Estimation of breast cancer overdiagnosis: Annals of Internal Medicine

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