Screening mammography: Is it suitably targeted to older women who are most likely to benefit?
OBJECTIVE
To determine whether screening mammography is suitably targeted to older women who are most likely to benefit.


METHODS
Prospective cohort study.


METHODS
New Haven County, Connecticut.


METHODS
Eight hundred forty-four community-dwelling older women were interviewed as part of the 1990 New Haven Established Populations for the Epidemiologic Study of the Elderly (EPESE) program.


METHODS
Mammography use was ascertained from Medicare Part B claims data. A four-level prognostic mortality index was developed using items previously shown to be predictive of mortality. Mammography use and all-cause mortality were evaluated by prognostic stage over a 5-year period, January 1, 1991, to December 31, 1995.


RESULTS
Five-year mortality increased steadily with each prognostic stage (12% to 68%, P = .001), whereas the 5-year mammography use rate declined (48% to 7%, P = .001). Over half the women (53%) in the most favorable prognostic group did not receive a mammogram, whereas 13% in the two worst prognostic groups received at least one mammogram.


CONCLUSIONS
Screening mammography may be underutilized among older women who are the most likely to benefit and overutilized among those who are unlikely to benefit.
Scinto
J D
JD
Qualidigm (formerly CPRO), Middletown, Connecticut, USA.
Gill
T M
TM
Grady
J N
JN
Holmboe
E S
ES
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000401:mortality / Q000517:prevention & control*; D003237:Connecticut / Q000453:epidemiology; D005260:Female; D006299:Health Services for the Aged / Q000458:organization & administration*; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data*; D006278:Medicare / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care; D011446:Prospective Studies; D012017:Referral and Consultation; D012307:Risk Factors; D014481:United States; D016387:Women's Health