Table 5.
Risk estimates for 5-year breast cancer and 10-year non-BC death, for example, women aged 75
| Example cases | Absolute Breast cancer risk | Absolute Breast cancer death risk | Absolute non-Breast cancer death risk | Guidelines recommenda,b |
|---|---|---|---|---|
| Case 1: A 75-year-old woman with BMI = 28, non-smoker, 25 alcoholic drinks per week, average walking pace, no functional limitations, has hypertension, has had a mammogram in the past 2 years, has 1 first-degree relative with breast cancer < 50, had 1 breast biopsy, past user of estrogen + progesterone > 5 years, age 55 at menopause and had 2 children, first birth at 30 | 3.1% 5-year | 0.38% 10-year | 11.7% 10-year | Shared decision making |
| Case 2: A 75-year-old woman with BMI = 23, past smoker, < 2 alcoholic drinks per week, slow walking pace, needs help getting dressed, has a history of cancer, has Parkinson’s, has depression, history of MI, has had a mammogram in the past 2 years, has no family history of breast cancer, age 50 at menopause and had 2 children, first birth at 28 | 1.7% 5-year | 0.27% 10-year | 69.8% 10-year | Consider stopping screening |
| Case 3: A 75-year-old woman with BMI = 22, non-smoker, non-drinker, average walking pace, no functional limitations, has had a mammogram in the past 2 years, age 48 at menopause, had 3 children, first birth at 22 | 1.3% 5-year | 0.15% 10-year | 9.8% 10-year | Shared decision making |
| Case 4: A 75-year-old woman with BMI = 35, former smoker, < 2 alcoholic drinks per week, slow walking pace, limited walking several blocks, has hypertension, diabetes, COPD, history of myocardial infarction, has not had a mammogram in the past 2 years, has 1 first-degree relative with breast cancer < 50, had 2 breast biopsies, past user of estrogen + progesterone > 5 years, age 55 at menopause and had no children | 4.3% 5-year | 0.44% 10-year | 57.8% 10-year | Consider stopping screening |
aGuidelines: The American Cancer Society and American College of Obstetrics and Gynecology recommend shared decision making around mammography screening for women aged 75 and older and to stop screening when life expectancy is < 10 years. The United States Preventive Services Task Force states the evidence is insufficient to recommend mammography screening to women ≥ 75 but encourages clinicians to be prepared to discuss this service if patients ask [7, 8, 11]
bPrior studies have estimated individuals with > 50% 10-year mortality risk to have < 10-year life expectancy since life expectancy is the median survival of a population; therefore, screening is not recommended for these women [38, 39]