Screening mammography and Pap tests among older American women 1996-2000: results from the Health and Retirement Study (HRS) and Asset and Health Dynamics Among the Oldest Old (AHEAD).
BACKGROUND
We wanted to determine the frequency of self-reported receipt of screening mammography and Papanicolaou (Pap) tests in older women and investigate important predictors of utilization, based on 2 national longitudinal surveys.


METHODS
This cohort study includes participants from 4 waves (1994-2000) of the Health and Retirement Study (HRS)--5,942 women aged 50 to 61 years, and 4 waves (1993-2000) of the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey--4,543 women aged 70 years and older. The self-reported receipt of screening mammograms and Pap smears in the most recent 2 years were reported in 1996 and 2000 for HRS, with predictors of receipt measured in 1994 and 1998. In AHEAD, the self-reported receipt of screening mammograms and Pap smears in the most recent 2 years were reported in 1995 and 2000, with predictors of receipt measured in 1993 and 1998.


RESULTS
Receipt of mammography is stable at 70% to 80% among women aged 50 to 64 years, then declines to around 40% among those aged 85 to 90 years. For Pap tests there is a decline from 75% among women aged 50 to 54 years to 25% in those aged 85 to 90 years. For both mammography and Pap tests, the rates increased in all groups from 1995/1996 to 2000. Higher education, being married, higher income, not smoking, and vigorous exercise were consistently associated with higher rates of receipt.


CONCLUSIONS
Although the use of mammography and Pap tests for screening declines into old age, use has been increasing recently. The large and increasing number of tests performed might not be justified given the lack of evidence of effect in older age-groups.
Ostbye
Truls
T
Department of Community and Family Medicine, Center for Health Policy, Law and Management, Duke University Medical Center, Chapel Hill, NC, USA. Truls.Ostbye@duke.edu
Greenberg
Gary N
GN
Taylor
Donald H
DH
Lee
Ann Marie M
AM
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000401:mortality / Q000517:prevention & control*; D003362:Cost-Benefit Analysis; D005260:Female; D006299:Health Services for the Aged / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008137:Longitudinal Studies; D008327:Mammography / Q000191:economics / Q000706:statistics & numerical data*; D008875:Middle Aged; D015999:Multivariate Analysis; D065006:Papanicolaou Test; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012306:Risk; D014481:United States / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000517:prevention & control*; D014626:Vaginal Smears / Q000191:economics / Q000706:statistics & numerical data*