To screen or not to screen: the issue of breast cancer screening in older women.
BACKGROUND
The United States Preventive Services Task Force (USPSTF) recommends that women aged 50-69 receive timely breast cancer screening, but does not make a recommendation for women aged 70 and older. Our purpose is to assess the relationship between age and breast cancer screening trends, and to consider the issue of breast cancer screening of women 70 years of age and older in light of demographics, disease burden, life expectancy, and activity level.


METHODS
Data were analyzed from the state-based Behvioral Risk Factor Surveillance System (BRFSS) and the National Health Interview Survey (NHIS) on breast cancer screening practices and activity limitation status of women 50 and older.


RESULTS
The percentage of women who reported receiving mammography and clinical breast examination within two years was lower among older women compared with younger women, and the gap has widened over time. In 1991-92, 61.4% of women 50-69 received screening within two years, compared to 49.5% of women 70 and above, while in 1997-98, the percentages were 71.1 and 56.7, respectively. Among both age groups and in both time periods, those unable to perform a major activity of daily living were less likely to report receiving mammography within two years than those with no limitation, and the gap was much wider in the elderly. Most (62.7%) women 70 and older reported having no activity limitation; only 5.5% reported being unable to perform a major activity.


CONCLUSIONS
These results suggest that elderly women are less likely than younger women to receive timely breast cancer screening. The USPSTF does not recommend continued screening in elderly women because most studies of breast cancer efficacy included inadequate numbers of these women. Few, if any, studies have yielded evidence that screening is ineffective in women 70 and over. Given the higher breast cancer incidence and mortality seen in elderly women, as well as the increased life expectancy with little or no activity limitation seen among today's elderly, consideration should be given to including elderly women in the recommendation to receive timely breast cancer screening. Since surgical and adjuvant therapy for breast cancer in older women has less complications than therapy for other cancers of the elderly, the cost-benefit ratio for breast cancer screening in this age group may prove to be more promising.
Caplan
L S
LS
Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA 30315, USA. lcaplan@msm.edu
D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D040343:Behavioral Risk Factor Surveillance System; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology; D016504:Breast Self-Examination / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D015994:Incidence; D008327:Mammography / Q000706:statistics & numerical data*; D008403:Mass Screening / Q000592:standards / Q000706:statistics & numerical data*; D008875:Middle Aged; D014481:United States / Q000453:epidemiology