A cohort study using SEER-Medicare data from the United States has found no evidence that continuing surveillance mammography beyond five years after diagnosis lowers the chance of detecting an advanced second breast cancer in older women. The absolute risk of that outcome was low in every group.
What was known
Surveillance mammography is widely used in older women with a history of breast cancer, yet the evidence that it improves clinical outcomes in this group is limited. Guidance stresses individualisation, and in practice decisions rest on life expectancy, comorbidity and patient preference rather than on a single schedule.
What this study adds
The authors analysed a retrospective cohort of 9,888 women diagnosed between 2004 and 2008 with nonmetastatic breast cancer at age 67 or older, using SEER registry data and Medicare claims. All had undergone a surveillance mammogram at approximately five years after diagnosis. Women who continued screening after that point (80.3%) were compared with those who did not, using cause-specific hazard models weighted by inverse probability of treatment; follow-up ran until December 2021. Mean age at cohort entry was 81.1 years.
Main results
At initial diagnosis, 81.4% of participants had in situ or localised disease and 76.9% had hormone receptor-positive tumours. Advanced second primary breast cancer was uncommon: cumulative incidence was 1.65% among women who continued surveillance and 2.15% among those who did not, with a hazard ratio of 0.76 (95% confidence interval, 0.46-1.26), that is, no statistically significant difference. Findings were similar when stratified by hormone receptor status of the initial tumour.
What it means
For older survivors, these data do not support the idea that keeping up mammography indefinitely will prevent advanced diagnoses. The authors conclude that decisions should be individualised, weighing the burden of continued testing —travel, anxiety, additional investigations— against a benefit that could not be demonstrated in this group. This is not an argument for abandoning follow-up, but for agreeing its intensity and duration with each patient.
A view from the breast unit
Breast units are the natural setting for reviewing follow-up pathways for older patients: how many appointments are booked automatically, whether comorbidity and preferences have been considered, and whether discharge from oncology follow-up is clearly communicated to primary care. Evidence like this helps frame those conversations openly, without presenting an annual mammogram as an unconditional obligation.
Reference: Richman IB, Long JB, Lindsay ME, Sheffrin M, Berger ER. Surveillance Mammography and Second Primary Breast Cancer Diagnosis Among Older Women With a History of Breast Cancer. JAMA Internal Medicine, 2026. DOI
