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Screening for breast cancer Screen women over 65

BMJ 1994; 309 doi: (Published 10 September 1994) Cite this as: BMJ 1994;309:664
  1. G C Sutton,
  2. S Balmer
  1. Wakefield Healthcare, Wakefield WF1 1LT
  2. South East Thames Regional Genetics Centre, Division of Medical and Molecular Genetics, Guy's Hospital, London SE1 9RT
  3. Centre for Research in Primary Care, University of Leeds, Leeds LS2 9LN Meanwood Health Centre, Leeds LS6 4JN
  4. Faculty of Medicine, Kuwait University, PO Box 24923, Kuwait.

    EDITOR, - The breast screening programme is expected to prevent 1250 breast cancer deaths a year in women invited for screening.1 We believe that an equivalent health gain would be achievable in women over 65 if they were also invited.

    The diagnostic powers of modern mammography and subsequent assessment procedures are proved for women over 65, but the response of these women to invitation is said to be low. In fact, uptake seems to be good to age 69 but variable thereafter (table). Much of this variation will reflect the different organisation of the studies. Thus in Britain invitations to women are preceded by a “prior notification” cycle of checks by general practitioners on the accuracy of the population list. This added some 5% to Manchester's figures,2 which suggests that 60% would be an attainable target for a first screening of 65 to 74 year olds in much of Britain. Rates for subsequent screenings would be lower.

    View this table:

    Effect of age on uptake of screening for breast cancer in four studies.* Figures are percentages

    The yield of cancers is high in older women. Reduction in mortality has been shown in women aged up to 74 on entry to screening but not beyond.3,4 Benefits on mortality are understated when reported as relative risks since older women have higher absolute risks. For instance, in the demonstration project in the United States the relative reduction in deaths from breast cancer was 24% in screened women aged 50 to 59 and 26% in those aged 60 to 74, but the absolute reductions were 103 and 140 deaths …

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