title: Improved prognosis of women aged 75 and older with mammography-detected breast cancer.
abstract: OBJECTIVE
  To evaluate the characteristics and outcomes of women aged 75 years and older with mammography-detected breast cancer, an age group not represented in mammography screening effectiveness studies.
  
  
  METHODS
  We conducted a HIPAA-compliant, prospective cohort study with waiver of informed consent in patients with primary breast cancer, aged 75 years and older, with stage 0-IV disease from 1990 to 2011, identified and tracked with our registry database (n = 1162). Details including stage, treatment, outcomes, and method of detection (by patient, physician, or mammography) were noted from the chart at the time of diagnosis. Kaplan-Meier estimation was used to compare invasive disease-specific survival rates.
  
  
  RESULTS
  Among patients with breast cancer aged 75 years and older, mammography detection of cancers increased over time, from 49% to 70% (P < .001). Mammography-detected cases were more often stage I (62%), whereas patient- and physician-detected cases were more likely stage II and III (59%). Over time, from 1990 to 2011, the incidence of stage II cancers decreased by 8%, the incidence of stage III cancers decreased by 8%, and the incidence of stage 0 cancers increased by 15% (P < .001). Patients with mammography-detected invasive breast cancer were more often treated with lumpectomy and radiation and underwent fewer mastectomies and less chemotherapy than patients with cancer detected by patients and physicians (P < .001). Mammography detection was associated with significantly better 5-year disease-specific survival for invasive breast cancer (97% vs 87% for patient- and physician-detected cancer [P < .001], respectively).
  
  
  CONCLUSIONS
  Mammography-detected breast cancer in women 75 years and older was diagnosed at an earlier stage, required less treatment, and had better disease-specific survival than patient- or physician-detected breast cancer. These findings indicate that the same benefits of mammography detection observed in younger women extend to older women.
authors.affiliation: From HealthStat Consulting, 12025 9th Ave NW, Seattle, WA 98177 (J.A.M.); School of Public Health,Department of Epidemiology, University of Washington, Seattle, Wash (J.A.M.); and Swedish Cancer Institute at Swedish Medical Center, Seattle, Wash (J.P., M.K.A., H.G.K.).
authors.forename: Judith A
authors.initials: JA
authors.lastname: Malmgren
authors.forename: Jay
authors.initials: J
authors.lastname: Parikh
authors.forename: Mary K
authors.initials: MK
authors.lastname: Atwood
authors.forename: Henry G
authors.initials: HG
authors.lastname: Kaplan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000473:pathology; D005260:Female; D006801:Humans; D008017:Life Expectancy; D008327:Mammography; D009367:Neoplasm Staging; D011159:Population Surveillance; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D014481:United States / Q000453:epidemiology