Targeting of Mammography Screening According to Life Expectancy in Women Aged 75 and Older

• Published in: Journal of the American Geriatrics Society (JAGS) Vol. 61; no. 3; pp. 388 - 395
• Main Authors: Schonberg, Mara A., Breslau, Erica S., McCarthy, Ellen P.
• Format: Journal Article
• Language: English
• Published: Hoboken, NJ Blackwell Publishing Ltd 01.03.2013; Wiley-Blackwell; Wiley Subscription Services, Inc
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Cross-Sectional Studies; Decision making; Female; General aspects; Genital system. Mammary gland; Health services utilization; Health Surveys; Humans; Investigative techniques, diagnostic techniques (general aspects); Life Expectancy; Mammography; Mammography - utilization; mammography screening; Mass Screening - utilization; Medical sciences; Multivariate Analysis; Older people; older women; Prevention and actions; Public health. Hygiene; Public health. Hygiene-occupational medicine; Radiodiagnosis. Nmr imagery. Nmr spectrometry; United States; Women; United States; Human; Life expectancy; Radiodiagnosis; Targeting; Mammography; older women; Medical screening; Screening; Gerontology; mammography screening; Adult; Female; Woman; Elderly; Age; Geriatrics
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/jgs.12123

Objectives To examine receipt of mammography screening according to life expectancy in women aged 75 and older. Design Population‐based survey. Setting United States. Participants Community dwelling U.S. women aged 75 and older who participated in the 2008 or 2010 National Health Interview Survey. Measurements Using a previously developed and validated index, women were categorized according to life expectancy (>9, 5–9, <5 years). Receipt of mammography screening in the past 2 years was examined according to life expectancy, adjusting for sociodemographic characteristics, access to care, preventive orientation (e.g., receipt of influenza vaccination), and receipt of a clinician recommendation for screening. Results Of 2,266 respondents, 27.1% had a life expectancy of greater than 9 years, 53.4% had a life expectancy of 5 to 9 years, and 19.5% had a life expectancy of less than 5 years. Overall, 55.7% reported receiving mammography screening in the past 2 years. Life expectancy was strongly associated with receipt of screening (P < .001), yet 36.1% of women with less than 5 years life expectancy were screened, and 29.2% of women with more than 9 years life expectancy were not screened. A clinician recommendation for screening was the strongest predictor of screening independent of life expectancy. Higher educational attainment, age, receipt of influenza vaccination, and history of benign breast biopsy were also independently associated with being screened. Conclusion Despite uncertainty of benefit, many women aged 75 and older are screened with mammography. Life expectancy is strongly associated with receipt of screening, which may reflect clinicians and patients appropriately considering life expectancy in screening decisions, but 36% of women with short life expectancies are still screened, suggesting that new interventions are needed to further improve targeting of screening according to life expectancy. Decision aids and guidelines encouraging clinicians to consider patient life expectancy in screening decisions may improve care.