Abstract
BackgroundAlthough guidelines recommend that clinicians consider life expectancy before screening older women for breast cancer, many older women with limited life expectancies are screened. We aimed to identify factors important to mammography screening decisions among women aged 80 and older compared to women aged 65–79.MethodsTelephone surveys of 107 women aged 80+ and 93 women aged 65–79 randomly selected from one academic primary care practice who were able to communicate in English (60% response rate). The survey addressed the following factors in regards to older women's mammography screening decisions: perceived importance of a history of breast disease, family history of breast cancer, doctor's recommendations, habit, reassurance, previous experience, mailed reminder cards, family/friend's recommendations or experience with breast cancer, age, health, and media. The survey also assessed older women's preferred role in decision making around mammography screening.ResultsOf the 200 women, 65.5% were non-Hispanic white and 82.8% were in good to excellent health. Most (81.3%) had undergone mammography in the past 2 years. Regardless of age, older women ranked doctor's recommendations as the most important factor influencing their decision to get screened. Habit and reassurance were the next two highly ranked factors influencing older women to get screened. Among women who did not get screened, women aged 80 and older ranked age and doctor's counseling as the most influential factors and women aged 65–79 ranked a previous negative experience with mammography as the most important factor. There were no significant differences in preferred role in decision-making around mammography screening by age, however, most women in both age groups preferred to make the final decision on their own (46.6% of women aged 80+ and 50.5% of women aged 65–79).ConclusionWhile a doctor's recommendation is the most important factor influencing elderly women's mammography screening decisions, habit and reassurance also strongly influence decision-making. Interventions aimed at improving clinician counseling about mammography, which include discussions around habit and reassurance, may result in better decision-making.
Highlights
Guidelines recommend that clinicians consider life expectancy before screening older women for breast cancer, many older women with limited life expectancies are screened
Interventions aimed at improving clinician counseling about mammography screening with older women, which include discussions around habit and reassurance, may result in more optimal decisionmaking
We found that shared decision-making around mammography screening between women aged 80 and older and their clinicians may result in better targeting of screening to older women in good health
Summary
Guidelines recommend that clinicians consider life expectancy before screening older women for breast cancer, many older women with limited life expectancies are screened. Experts generally agree that a woman needs 5 to even 10 years of life expectancy to potentially benefit from mammography screening [1,2]. Benefits of mammography screening among older women include possibly prolonging life or preventing morbidity associated with advanced breast cancer [3,4]. Guidelines recommend that clinicians consider older women's life expectancy and comorbidities before recommending mammography screening [5,6]. More women aged 80 and older are undergoing mammography screening and evidence suggests it is not being targeted to the oldest women in the best health and most likely to benefit [7,8]
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