Forum: Fit women above 70 should continue to have breast cancer screening

We refer to the recent article by senior health correspondent Salma Khalik (Should older women go for breast cancer screening? Experts divided, Aug 26) and the Forum letter by Dr Desmond Wai (Balance benefits of breast cancer screening against potential harms, Sept 5).

As clinicians managing newly diagnosed breast cancer patients daily, we strongly believe that breast cancer screening should continue beyond age 70. We continue to see elderly seniors in their 70s to 80s with stage 2 and above breast cancers, presenting symptomatically with a self-detected breast lump.

These cancers may become debilitating and eventually life-threatening if left untreated, and likely would have been detected and treated at earlier stages if the women had continued screening after age 70. Treatment of breast cancer in the earlier stages is generally less complex with better outcomes. 

The risk of false positives from screening is always present regardless of age of screening.

The managing clinician should assess not only the risk of cancer in the screen-detected abnormality, but also each individual patient’s risk factors, general health status and co-existing medical conditions, life expectancy and possible treatment options should cancer be found. The clinician then discusses the pros and cons of pursuing further evaluation of the screening abnormality with the patient, so that the patient may make an informed decision for herself. This is the “balanced” approach in breast cancer screening.

We acknowledge that screen-detected breast cancer will have a varying extent of severity but each patient deserves to know her available options in the event of an abnormal screening result.  

Many of our female seniors often mistakenly think they are no longer at risk of breast cancer when they stop receiving invitations to attend the national breast cancer screening programme BreastScreen Singapore after age 70. This is despite the average life expectancy for women in Singapore being 85.2 years.  

Let us not confuse them further. With October being breast cancer awareness month, we should have a consistent message to our seniors that breast cancer screening after age 70 should continue as long as the woman remains well and fit with a life expectancy of 10 years or more. After all, active ageing also means healthy ageing.  

Tan Yah Yuen (Dr)
(Co-signed by nine other doctors)

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