Data-Driven Mammography Screening Practices—Reply

In Reply Drs Seidenwurm and Breslau state in their letter that women in their 80s and 90s are not likely to live long enough to benefit from early detection, but such a blanket statement is both incorrect and dangerous; many such women remain healthy with at least 5 to 10 years of life expectancy. Indeed, multiple observational and modeling studies have demonstrated that women 75 years and older who undergo regular mammography not only will be diagnosed with earlier-stage cancers but also will experience a significant number of life-years gained and a significant reduction in breast cancer mortality. In fact, screening mammography in aging populations detects disease at an earlier stage and reduces recognized age disparities in breast cancer mortality. The benefits of screening older women are the same as in younger women—early detection of smaller, node-negative tumors and less invasive and/or toxic cancer treatment, resulting in life-years gained and decreased breast cancer mortality except for women with substantial comorbidity or limited life expectancy.

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