Mammography screening programme: also useful for women over 70

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According to a recent scientific report by the Federal Office for Radiation Protection (BfS), women between the ages of 70 and 75 could also benefit from the mammography screening programme for the early detection of breast cancer. The BfS therefore advocates extending the age limit for participants to 75 years. Until now, the limit was 69 years. The BfS report on this was published in the Federal Gazette and on the BfS website in December.

"Extending the age limit can be a step towards further reducing mortality from breast cancer", says BfS President Inge Paulini. "Mammography screening is a quality-assured programme for women between 50 and 69 years of age that has been offered throughout Germany since 2009. Also for women between 70 and 75, the benefits of participation outweigh the disadvantages from a radiation protection perspective."

Possible benefits for older women investigated

Currently, women between the ages of 50 and 69 are invited to undergo screening mammography every two years. Mammography is currently the only X-ray procedure approved in Germany for early detection.

President of the Federal Office for Radiation Protection, Dr Inge Paulini

The BfS report provides the scientific basis for a possible approval for expanding the existing mammography screening programme in Germany. The Federal Ministry for the Environment, Nature Conservation, Nuclear Safety and Consumer Protection (BMUV) may grant this authorisation in the form of a statutory order. But until a statutory order comes into force, this early breast cancer detection is prohibited for women aged 70 and over.

Breast cancer is the most common form of cancer as well as the most common cause of death from cancer among women in Germany. In the early stages, mammary carcinomas can be easily treated. However, because they are often not noticeable at this stage, early detection through mammography plays an essential role. On behalf of the BMUV, the BfS investigated whether women aged 70 and over could also benefit from early detection.

Scientifically weighing the benefits and risks of early detection

For the report, the BfS evaluated nine publications on two randomised controlled trials from the 1970s. The analysis, which included data from almost 20,000 women aged 70 and older, also found indications of a benefit of screening for women under 75.

Data from the Dutch mammography screening programme, which includes women up to 74 years of age, were used as a supplement as well as findings on the higher age groups in the German programme. Both support the results of the randomised controlled trials, according to which older women can also benefit from early detection.

The risk–benefit assessment is central to the BfS reports on early detection. This is because the screening is aimed at women without symptoms of disease. However, only a small proportion of these women actually have the disease and can get an immediate benefit from the screening. However, the risks (e.g. from the radiation exposure associated with the mammograms) affect all participants.

Screening justified for women up to 75

Because the radiation-related risk cancer decreases considerably with increasing age, this is practically negligible when screening women over 70.

The situation is different for the risk of overdiagnosis (i.e. the diagnoses of tumours that would not have been noticed during the person's lifetime without screening and would not have required treatment). This risk is difficult to quantify. However, because of the lower remaining life expectancy, it affects mainly older women.

From the perspective of radiation protection, the continuation of quality-assured screening in women up to the age of 75 is justified. Thus, at an interval of two years, all women aged 70 and over could be offered three additional screenings.