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Breast Cancer Screening in Elderly Women Primum Non Nocere

Ismail Jatoi, MD, PhD1; Anthony B. Miller, MD, FRCP, FRCP(C)2
[+] Author Affiliations
1Division of Surgical Oncology and Endocrine Surgery, University of Texas Health Science Center, San Antonio
2Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
JAMA Surg. 2015;150(12):1107-1108. doi:10.1001/jamasurg.2015.2663.
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This Viewpoint discusses clinical breast examination as an alternative to screening mammography in elderly women.

In elderly women (defined here as those 70 years and older), screening mammography may do more harm than good, and we believe that screening clinical breast examination (CBE) should be evaluated as an alternative. Indeed, when considering breast cancer screening in elderly women, one should recall a key principle of bioethics, primum non nocere (first, do no harm). Mammography is a sensitive screening test, and this sensitivity exposes elderly women to substantial harms (ie, false-positives, lead time, and overdiagnosis).1 Moreover, in older women, the effect of mammography screening on breast cancer mortality remains uncertain, as there are very limited data from randomized trials. Yet, advancing age is the single greatest risk factor for the development of breast cancer in women, and large numbers of American women continue to obtain annual screening mammograms beyond age 70 years.2

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