title: Screening mammography: Is it suitably targeted to older women who are most likely to benefit?
abstract: 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.
authors.affiliation: Qualidigm (formerly CPRO), Middletown, Connecticut, USA.
authors.forename: J D
authors.initials: JD
authors.lastname: Scinto
authors.forename: T M
authors.initials: TM
authors.lastname: Gill
authors.forename: J N
authors.initials: JN
authors.lastname: Grady
authors.forename: E S
authors.initials: ES
authors.lastname: Holmboe
mesh_terms: 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