Screening Mammography In Older Women Research Articles

Women 75 Years Old or Older: To Screen or Not to Screen?

Breast cancer is the most common cancer in women, with the incidence rising substantially with age. Older women are a vulnerable population at increased risk of developing and dying from breast cancer. However, women aged 75 years and older were excluded from all randomized controlled screening trials, so the best available data regarding screening benefits and risks in this age group are from observational studies and modeling predictions. Benefits of screening in older women are the same as those in younger women: early detection of smaller lower-stage cancers, resulting in less invasive treatment and lower morbidity and mortality. Mammography performs significantly better in older women with higher sensitivity, specificity, cancer detection rate, and positive predictive values, accompanied by lower recall rates and false positives. The overdiagnosis rate is low, with benefits outweighing risks until age 90 years. Although there are conflicting national and international guidelines about whether to continue screening mammography in women beyond age 74 years, clinicians can use shared decision making to help women make decisions about screening and fully engage them in the screening process. For women aged 75 years and older in good health, continuing annual screening mammography will save the most lives. An informed discussion of the benefits and risks of screening mammography in older women needs to include each woman's individual values, overall health status, and comorbidities. This article will review the benefits, risks, and controversies surrounding screening mammography in women 75 years old and older and compare the current recommendations for screening this population from national and international professional organizations. ©RSNA, 2023 Quiz questions for this article are available through the Online Learning Center.

Abstract 2531: Function-related indicator and outcomes of screening mammography in older women from the BCSC-Medicare Cohort

Abstract Background: Although there is evidence pointing to the role of comorbidity and age in screening mammography outcomes among older women, the impact of functional decline on mortality in this population is unknown. Methods: We used data from 238,849 women in the Breast Cancer Surveillance Consortium-Medicare (BCSC) linked database from 1999-2015 who had at least one screening mammogram at ages 66-94 years. We estimated the 10-year cumulative incidence of breast cancer, breast cancer death, and non-breast cancer death by function-related indicator (FRI) which incorporated 16 claims-based items reflecting functional or health status in older people. In the analysis, FRI score was categorized as an ordinal variable (0, 1, and 2+) and a higher score indicated a higher burden of functional limitations. Fine and Gray proportional sub-distribution hazards models were applied with incident breast cancer and death treated as competing events. Risk estimates by FRI scores (0, 1, and 2+) were adjusted by age and NCI comorbidity index separately and stratified by these factors. Results: During a median follow-up of 101 months, 9,252 women were diagnosed with breast cancer. During follow-up, 406 women died of breast cancer and 41,640 died from non-breast cancer causes. The 10-year age-adjusted cumulative incidence of invasive breast cancer slightly decreased with increasing FRI score (FRI=0: 4.0%, 95% CI=3.8%-4.1%; FRI=1: 3.9%, 95% CI=3.7%-4.2%; FRI=2+: 3.5%, 95% CI=3.1%-3.9%). Risk of death from non-breast cancer causes increased with FRI score (FRI=0: 18.8%, 95% CI=18.5%-19.1%; FRI=1: 24.4%, 95% CI=23.9%-25.0%; FRI=2+: 39.8%, 95% CI=38.8%-40.9%). Risk of breast cancer death was low with minimal risk differences across FRI scores (FRI=0: 0.24%, 95%CI=0.20%-0.28%; FRI=1: 0.20%, 95%CI=0.14%-0.26%; FRI=2+: 0.30%, 95% CI=0.18%-0.42%). Risk estimates in NCI comorbidity index-adjusted models were largely similar to outcomes in age-adjusted models. Stratified analyses suggested similar patterns of risk estimates by FRI. Conclusion: Cumulative risk of death from non-breast cancer causes substantially increases with FRI score, suggesting that the potential of screening mammography to benefit older women is low among those with a high burden of functional limitation. Citation Format: Dongyu Zhang, Linn Abraham, Joshua Demb, Diana L. Miglioretti, Shailesh Advani, Brian L. Sprague, Louise M. Henderson, Tracy Onega, Karen Wernli, Louise C. Walter, Karla Kerlikowske, John T. Schousboe, Ellen S. O'Meara, Dejana Braithwaite. Function-related indicator and outcomes of screening mammography in older women from the BCSC-Medicare Cohort [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2531.

Function-related Indicators and Outcomes of Screening Mammography in Older Women: Evidence from the Breast Cancer Surveillance Consortium Cohort.

Previous reports suggested risk of death and breast cancer varied by comorbidity and age in older women undergoing mammography. However, impacts of functional limitations remain unclear. We used data from 238,849 women in the Breast Cancer Surveillance Consortium-Medicare linked database (1999-2015) who had screening mammogram at ages 66-94 years. We estimated risk of breast cancer, breast cancer death, and non-breast cancer death by function-related indicator (FRI) which incorporated 16 claims-based items and was categorized as an ordinal variable (0, 1, and 2+). Fine and Gray proportional sub-distribution hazards models were applied with breast cancer and death treated as competing events. Risk estimates by FRI scores were adjusted by age and NCI comorbidity index separately and stratified by these factors. Overall, 9,252 women were diagnosed with breast cancer, 406 died of breast cancer, and 41,640 died from non-breast cancer causes. The 10-year age-adjusted invasive breast cancer risk slightly decreased with FRI score [FRI = 0: 4.0%, 95% confidence interval (CI) = 3.8-4.1; FRI = 1: 3.9%, 95% CI = 3.7-4.2; FRI ≥ 2: 3.5%, 95% CI = 3.1-3.9). Risk of non-breast cancer death increased with FRI score (FRI = 0: 18.8%, 95% CI = 18.5-19.1; FRI = 1: 24.4%, 95% CI = 23.9-25.0; FRI ≥ 2: 39.8%, 95% CI = 38.8-40.9]. Risk of breast cancer death was low with minimal differences across FRI scores. NCI comorbidity index-adjusted models and stratified analyses yielded similar patterns. Risk of non-breast cancer death substantially increases with FRI score, whereas risk of breast cancer death is low regardless of functional status. Older women with functional limitations should be informed that they may not benefit from screening mammography.

Primary care provider perspectives on screening mammography in older women: A qualitative study.

Guidelines informing screening mammography for older women are lacking. This study sought to characterize PCP perspectives on screening mammography for patients aged 75 and older. This was an exploratory, qualitative study based on semi-structured, one-on-one interviews with PCPs from six clinics affiliated with a tertiary medical center. Two independent coders analyzed interview transcripts and identified themes, subthemes, and representative quotes using inductive analysis methodology. Ten providers completed interviews. The majority (90%) of providers reported insufficient evidence to suggest a best practice for screening in this population. Providers relied on shared decision-making with patients, a process facilitated by strong provider-patient relationships. Providers took into consideration factors such as functional status, personal risk of breast cancer, and patient preference. Time constraints disincentivized providers to engage in discussions. PCPs make decisions about screening mammography for older patients on an individualized basis, taking into account patient overall health status and desire for aggressive intervention. They often rely on shared decision-making given unclear clinical guidelines. These findings suggest that fostering strong provider-patient relationships, addressing patient knowledge gaps, and compensating providers for time spent on counseling may facilitate cost-efficient and patient-centered utilization of screening mammography.

Optimism may moderate screening mammogram frequency in Medicare: A longitudinal study.

Higher trait optimism and/or lower cynical hostility are associated with healthier behaviors and lower risk of morbidity and mortality, yet their association with health care utilization has been understudied. Whether these psychological attitudes are associated with breast cancer screening behavior is unknown. To assess the association of optimism and cynical hostility with screening mammography in older women and whether sociodemographic factors acted as mediators of these relationships, we used Women's Health Initiative (WHI) observational cohort survey data linked to Medicare claims. The sample includes WHI participants without history of breast cancer who were enrolled in Medicare Parts A and B for ≥2 years from 2005–2010, and who completed WHI baseline attitudinal questionnaires (n = 48,291). We used survival modeling to examine whether screening frequency varied by psychological attitudes (measured at study baseline) after adjusting for sociodemographic characteristics, health conditions, and healthcare-related variables. Psychological attitudes included trait optimism (Life Orientation Test-Revised) and cynical hostility (Cook Medley subscale), which were self-reported at study baseline. Sociodemographic, health conditions, and healthcare variables were self-reported at baseline and updated through 2005 as available. Contrary to our hypotheses, repeated events survival models showed that women with the lowest optimism scores (i.e., more pessimistic tendencies) received 5% more frequent screenings after complete covariate adjustment (p < .01) compared to the most optimistic group, and showed no association between cynical hostility and frequency of screening mammograms. Sociodemographic factors did not appear to mediate the relationship between optimism and screenings. However, higher levels of education and higher levels of income were associated with more frequent screenings (both p < .01). We also found that results for optimism were primarily driven by women who were aged 75 or older after January 2009, when changes to clinical guidelines lead to uncertainty about risks and benefits of screening in this age group. The study demonstrated that lower optimism, higher education, and higher income were all associated with more frequent screening mammograms in this sample after repeated events survival modeling and covariate adjustment.

Digital 2D versus Tomosynthesis Screening Mammography among Women Aged 65 and Older in the United States.

Background Although breast cancer incidence and mortality rates increase with advancing age, there are limited data on the benefits and risks of screening mammography in older women and on the performance of two-dimensional digital mammography (DM) and digital breast tomosynthesis (DBT) in older women. Purpose To compare performance metrics of DM and DBT among women aged 65 years and older. Materials and Methods For this retrospective study, consecutive screening mammograms in patients aged 65 years and older from March 2008 to February 2011 (DM group) and from January 2013 to December 2015 (DBT group) were reviewed. Cancer detection rate, abnormal interpretation rate, positive predictive values, sensitivity, and specificity were calculated. Multivariable logistic regression models were fit to compare performance metrics in the DM versus DBT groups. Results The DM group had 15 019 women (mean age ± standard deviation, 72.7 years ± 6.3), and the DBT group had 20 646 women (mean age, 72.1 years ± 5.9). After adjusting for multiple variables, there was no difference in cancer detection rate between the DM and DBT groups (6.9 vs 8.2 per 1000 examinations; adjusted odds ratio [AOR], 1.13; P = .23). Compared with the DM group, the DBT group had a lower abnormal interpretation rate (5.7% vs 5.8%; AOR, 0.88; P < .001), higher positive predictive value 1 (14.5% vs 11.9%; AOR, 1.26; P = .03), and higher specificity (95.1% vs 94.8%; AOR, 1.18; P < .001). The DBT group had a higher proportion of invasive cancers relative to in situ cancers (81.1% vs 74.4%; P = .06) and fewer node-positive cancers (10.2% vs 16.6%; P = .054) than did the DM group. Conclusion In women aged 65 years and older, integration of digital breast tomosynthesis led to improved performance metrics, with a lower abnormal interpretation rate, higher positive predictive value 1, and higher specificity. © RSNA, 2019 See also the editorial by Philpotts and Durand in this issue.

Screening Mammography Among Older Women: A Review of United States Guidelines and Potential Harms.

In the United States, older women (aged ≥65 years) continue to receive routine screening mammography surveillance, despite limited evidence supporting the benefits to this subpopulation. This article reviews screening mammography guidelines and the potential harms of such screening for older women in the United States. Published guidelines and recommendations on screening mammography for older women from professional medical societies and organizations in the United States were reviewed from the mid-20th century to present. Observational data were then synthesized to present the documented harms from screening mammography among older women. In 1976, the American Cancer Society recommended to screen all women aged ≥40 years with no upper age limit. With time, other major U.S. medical societies adopted their own screening guidelines without a consensus on age of screening cessation. A population-wide screening effort has largely continued without an upper age limit and with it, a growing body of literature on the harms of screening older women. Reported harms from screening mammography procedures have included physical pain, psychological distress, excessive use of health services from overdiagnoses/false positives, and undue financial expenses. These costs are particularly pronounced among special populations with limited life expectancies such as those of very advanced age ≥80 years, long-term nursing home residents, and the cognitively impaired. When potential harms, remaining life years, and the viability of available treatments are considered, the burdens of screening mammography often outweigh the benefits for older women. For some cases, an individualized approach to recommendations would be appropriate. National guidelines should be updated to provide clear guidance for screening women of advanced age, especially those in special populations with limited life expectancies.

Screening for Breast Cancer in Women Age 75 Years and Older.

Older women undergoing regular mammography experience significant reductions in breast cancer mortality, except in women with severe comorbidities or limited life expectancy. Optimizing screening strategies requires informed discussions of benefits and risks given each woman's health status. This article will review the benefits and risks of screening mammography in women older than 75 years within the context of life expectancy and comorbidities and summarize the current recommendations from professional organizations for screening mammography in older women.

Differential Use of Screening Mammography in Older Women Initiating Metformin versus Sulfonylurea

Differential Use of Screening Mammography in Older Women Initiating Metformin versus Sulfonylurea

Utilization of screening mammography in older women according to comorbidity and age: protocol for a systematic review.

BackgroundApproximately half of new invasive breast cancer cases diagnosed each year in the United States occur among women aged 65 years and older. The increasing life expectancy coupled with the attendant rise in breast cancer incidence and elimination of out-of-pocket expenses for screening mammography as a result of the Affordable Care Act could lead to higher utilization rates of screening mammography. Although research indicates that life expectancy should be a strong consideration when making screening decisions among older women, the extent to which screening mammography utilization is tailored to comorbidity and life expectancy is not well established.Methods/designTo identify relevant studies, a systematic search of the literature will be conducted using PubMed and EMBASE between January 1, 1991, and March 1, 2016. Additional studies will be found through citation review or by contacting experts in the field. The inclusion criteria will be any study design comprised of women aged 65 and older, assessing women’s comorbidity, functional impairments, and/or health status, and reporting outcome measures that addressed mammography utilization within the last 1–5 years. For each study, two authors will independently abstract data regarding study eligibility and outcomes to determine relevance. Quantitative results will be extracted from text and tables, choosing preferably those adjusted for important confounders.DiscussionThe review will provide evidence on the impact of comorbidity, functional limitations, and health status on screening mammography utilization in older women and inform decision aids in this area.Systematic review registrationPROSPERO CRD42016032661 Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-016-0345-y) contains supplementary material, which is available to authorized users.

Multilevel factors associated with long-term adherence to screening mammography in older women in the U.S.

In the U.S., guidelines recommend that women continue mammography screening until at least age 74, but recent evidence suggests declining screening rates in older women. We estimated adherence to screening mammography and multilevel factors associated with adherence in a longitudinal cohort of older women. Women aged 66–75years receiving screening mammography within the Breast Cancer Surveillance Consortium were linked to Medicare claims (2005–2010). Claims data identified baseline adherence, defined as receiving subsequent mammography within approximately 2years, and length of time adherent to guidelines. Characteristics associated with adherence were investigated using logistic and Cox proportional hazards regression models. Analyses were stratified by age to investigate variation in relationships between patient factors and adherence. Among 49,775 women, 89% were adherent at baseline. Among women 66–70years, those with less than a high school education were more likely to be non-adherent at baseline (odds ratio [OR] 1.96; 95% confidence interval [CI] 1.65–2.33) and remain adherent for less time (hazard ratio [HR] 1.41; 95% CI 1.11–1.80) compared to women with a college degree. Women with ≥1 versus no Charlson co-morbidities were more likely to be non-adherent at baseline (OR 1.46; 95% CI 1.31–1.62) and remain adherent for less time (HR 1.44; 95% CI 1.24–1.66). Women aged 71–75 had lower adherence overall, but factors associated with non-adherence were similar. In summary, adherence to guidelines is high among Medicare-enrolled women in the U.S. receiving screening mammography. Efforts are needed to ensure that vulnerable populations attain these same high levels of adherence.

Optimal breast cancer screening strategies for older women: current perspectives.

Breast cancer is a major cause of cancer-related deaths among older women, aged 65 years or older. Screening mammography has been shown to be effective in reducing breast cancer mortality in women aged 50–74 years but not among those aged 75 years or older. Given the large heterogeneity in comorbidity status and life expectancy among older women, controversy remains over screening mammography in this population. Diminished life expectancy with aging may decrease the potential screening benefit and increase the risk of harms. In this review, we summarize the evidence on screening mammography utilization, performance, and outcomes and highlight evidence gaps. Optimizing the screening strategy will involve separating older women who will benefit from screening from those who will not benefit by using information on comorbidity status and life expectancy. This review has identified areas related to screening mammography in older women that warrant additional research, including the need to evaluate emerging screening technologies, such as tomosynthesis among older women and precision cancer screening. In the absence of randomized controlled trials, the benefits and harms of continued screening mammography in older women need to be estimated using both population-based cohort data and simulation models.

Multilevel factors associated with long-term adherence to screening mammography in older women in the U.S.

Multilevel factors associated with long-term adherence to screening mammography in older women in the U.S.

Screening Mammography in Older Women

Guidelines recommend individualizing screening mammography decisions for women aged 75 years and older. However, little pragmatic guidance is available to help counsel patients. To provide an evidence-based approach for individualizing decision-making about screening mammography in older women. We searched PubMed for English-language studies in peer-reviewed journals published from January 1, 1990, to February 1, 2014, to identify risk factors for late-life breast cancer in women aged 65 years and older and to quantify the benefits and harms of screening mammography for women aged 75 years and older. Age is the major risk factor for developing and dying from breast cancer. Breast cancer risk factors that reflect hormonal exposures in the distant past, such as age at first birth or age at menarche, are less predictive of late-life breast cancer than factors indicating recent hormonal exposures such as high bone mass or obesity. Randomized trials of the benefits of screening mammography did not include women older than 74 years. Thus it is not known if screening mammography benefits older women. Observational studies favor extending screening mammography to older women who have a life expectancy of more than 10 years. Modeling studies estimate 2 fewer breast cancer deaths/1000 women who in their 70s continue biennial screening for 10 years instead of stopping screening at age 69. Potential harms of continued screening over 10 years include false-positive mammograms in approximately 200/1000 women screened and overdiagnosis (ie, finding breast cancer that would not have clinically surfaced otherwise) in approximately 13/1000 women screened. Providing information about life expectancy along with potential benefits and harms of screening may help older women's decision-making about screening mammography. For women with less than a 10-year life expectancy, recommendations to stop screening mammography should emphasize increased potential harms from screening and highlight health promotion measures likely to be beneficial over the short term. For women with a life expectancy of more than 10 years, deciding whether potential benefits of screening outweigh harms becomes a value judgment for patients, requiring a realistic understanding of screening outcomes.

Screening mammography in older women: the balance between appropriate use and overuse

263 ISSN 1758-1923 10.2217/BMT.13.24 © 2013 Future Medicine Ltd Breast Cancer Manage. (2013) 2(4), 263–265 The incidence of female breast cancer gen‐ erally increases with age, with a median age of 61 years at the time of diagnosis. Women aged 65 years and older comprise approximately 35% of incident breast can‐ cer cases and 57% of breast cancer deaths [1]. The likelihood of death from breast cancer increases with advanced stage and larger tumor size at diagnosis. An impor‐ tant strategy to reduce such deaths is to screen asymptomatic women with mam‐ mography in order to detect and treat breast cancer in its preclinical stage and improve survival. However, ubiquitous mammographic screening among older women may not confer the expected ben‐ efit, but instead may result in unintended harms. For example, there is at least a 4‐year lag between screen‐detected breast cancer and onset of clinical symptoms for women aged 65–74 years [2]. Mammo‐ graphy trials found no survival difference between screened and unscreened women before 7 years of follow‐up for women aged 65–74 years [3]. In older women with lim‐ ited life expectancy, the delayed screening benefit does not have sufficient time to emerge because of competing risks. In fact, such women may be exposed to immediate physical and psychological harms caused by false‐positive results, invasive diagnostic tests, and overdiagnosis and overtreatment of breast cancer that otherwise would not have been diagnosed and treated in their lifetime [4,5]. High‐quality screening mam‐ mography services need to strike a balance between appropriate use and overuse; that is, they must screen older women who have a long enough life expectancy to benefit and avoid screening those with limited life expectancy. Both underuse and overuse of screen‐ ing mammography are evident among older women. Current cancer screening guidelines generally set age limits in their recommendations. For example, the US Preventive Services Task Force recom‐ mends regular screening mammography for women aged 50–74 years and individu‐ alized screening decisions for those aged 75 years and older [6]. It was estimated that, among women aged 75–90 years, approxi‐ mately 80% had an estimated life expec‐ tancy of 7 or more years and 60% had a life expectancy of 10 or more years [7,8]. With the rapid growth of the aging population, the proportion of such healthy, very old persons is expected to increase accordingly.

Abstract 157: Mammography interval and breast cancer mortality in the Women's Health Initiative.

Abstract Background: The 2009 U.S. Preventive Services Task Force (USPSTF) statement on screening for breast cancer suggests the lack of evidence for mammography for women 75 years or older based on the premise that disease would be indolent at advanced age. Analysis of the Women's Health Initiative (WHI) data refute this hypothesis, in that over 60% of breast cancers diagnosed between ages 70 to 79 were moderately or poorly differentiated. In order to better understand the role of screening mammography in older women, we evaluated the relationship between the time interval from breast cancer diagnosis to the last prior mammogram, and mortality due to breast cancer in the WHI. Methods: The study sample included 8,663 women enrolled in the WHI observational study (OS) or clinical trial (CT) who were diagnosed with breast cancer over an average of 12.2 (2.6 SD) years of follow-up (1,670 with insitu disease). Information on mammography was obtained annually or semi-annually from medical record update forms. Mammography interval was defined as the time between the date of diagnosis, and the last self- reported mammogram completed &amp;gt; 6 months prior to diagnosis. Self- and interviewer-administered questionnaires were used to collect information on other risk factors. Cox proportional hazards regression was used to analyze the association between mammography interval and breast cancer mortality stratified by age at diagnosis (50-74 vs 75+). Statistical tests were two-sided. Results: Prior mammograms were reported by 30% of women within &amp;gt; 6 months to &amp;lt; 1 year of diagnosis, 47% between 1 to &amp;lt; 2 years, 17.2% between 2 to 5 years and 5.8 % at &amp;gt; 5 years, or none at all. Longer interval was associated with advanced stage with 23% of women who had an interval of &amp;gt; 5 years diagnosed with regional or distant disease, compared to 20% of women with an interval of &amp;gt; 6 months to &amp;lt; 1 year, p=0.05. Women with a longer interval were also more likely to have estrogen receptor negative disease (22% vs 16%, p=0.03). In a model adjusted for age, race/ethnicity, OS or CT, health insurance, marital status, Charlson co-morbidity index, and body mass index, longer mammography interval as compared to an interval of &amp;gt; 6 months to &amp;lt; 1 year (referent), was significantly associated with increased breast cancer mortality for women &amp;gt; age 75 at diagnosis. A significant association was not seen for women age 50 to 74. For women &amp;gt; age 75, an interval of &amp;gt; 2 to &amp;lt; 5 years resulted in a hazard ratio (HR) of death from breast cancer of 1.87 (95% CI, 1.10 to 3.19), and an interval of &amp;gt; 5 years or no mammogram, resulted in a HR of 3.17 (95% CI, 1.68-5.96), p-trend 0.0001. For women age 50-74, the respective HR's and 95% CI were 1.05 (0.75-1.46) and 1.28 (0.8-2.06), p-trend 0.43. Conclusions: Extended time between breast cancer diagnosis and the last mammogram had a significant impact on breast cancer mortality for women diagnosed after age 75, suggesting a role for continued screening to reduce breast cancer mortality in older women. Citation Format: Michael S. Simon, Sylvia Wassertheil-Smoller, Cynthia A. Thompson, Roberta M. Ray, F Allan Hubell, Dorothy Lane, Lawrence Lessin, Hema Vankayala, Lew Kuller. Mammography interval and breast cancer mortality in the Women's Health Initiative. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 157. doi:10.1158/1538-7445.AM2013-157

Refining Physician Quality Indicators for Screening Mammography in Older Women: Distinguishing Appropriate Use from Overuse

To assess the feasibility of refining physician quality indicators of screening mammography use based on patient life expectancy. Retrospective population-based cohort study. Texas. Three thousand five hundred ninety-five usual care providers (UCPs) with at least 10 female patients aged 67 and older on January 1, 2008, with an estimated life expectancy of 7years or more (222,584 women) and at least 10 women with an estimated life expectancy of less than 7years (90,903 women), based on age and comorbidity. Screening mammography use in 2008-09 by each provider in each population. The average adjusted mammography screening rates for UCPs were 31.1% for women with a life expectancy of less than 7years and 55.2% for women with a life expectancy of 7years or longer. For women with limited life expectancy, 3.7% of UCPs had significantly lower and 9.2% had significantly higher than average adjusted mammography screening rates. For women with longer life expectancy, 16.7% of UCPs had significantly lower and 19.7% had significantly higher than average rates. UCP adjusted screening rates were stable over time (2006-07 vs 2008-09, correlation coefficient (r)=0.65, P<.001). There was a strong correlation between UCP screening rates for their female patients with a life expectancy of less than 7years and 7years or longer (r=0.67, P<.001). Most physician characteristics associated with higher screening rates (e.g., being female and foreign trained) in women with longer life expectancy were also associated with higher screening rates in women with limited life expectancy. Providers with high mammography screening rates for women with longer life expectancy also tend to screen women with limited life expectancy. Quality indicators for screening practice can be improved by distinguishing appropriate use from overuse based on patient life expectancy.

Benefits and Harms of Screening Mammography Frequency by Age and Comorbidity Score

Abstract Background: There is uncertainty about the appropriate use of screening mammography in older women. We compared the benefits and harms of screening mammography frequency according to age and comorbidity scores. Methods: We conducted analyses within a prospective cohort study of four mammography registries in the Breast Cancer Surveillance Consortium that had mammography data linked to Medicare claims information. Participants included 137,949 women aged 66–89 years without breast cancer and 2,993 women with breast cancer. We estimated odds of advanced (IIb, III, IV) stage, large tumor size (&amp;gt;20 millimeters), and estrogen receptor (ER) negative tumors and cumulative probability of false-positive mammography after 10 years of screening by mammography frequency, age and comorbidity score as determined by the Charlson Comorbidity Index. Results: Mammography biennially vs. annually for women aged 66–89 years does not increase risk of tumors with unfavorable characteristics regardless of women's comorbidity score. Cumulative probability of a false-positive result for annual and biennial screening of women aged 66–89 years with a comorbidity score of ≥1 was 48 (46.1, 49.9) and 29 (28.1, 29.9) respectively. False-positives were more common among annual screeners than among those screened biennially irrespective of women's comorbidity score. Conclusion: Mammography annually vs. biennially does not have added benefit for women aged 66–89 years, even among those in good overall health as reflected by the lack of comorbidity. Risk of false-positive mammography is much higher with annual mammography.

Making Decisions About Screening Mammography in Older Women

Making Decisions About Screening Mammography in Older Women

Accuracy of Screening Mammography in Older Women

Accuracy of Screening Mammography in Older Women