title: Primary care providers' concerns and recommendations regarding mammography screening for older women.
abstract: BACKGROUND
  Morbidity and mortality from breast cancer increase with age; however, mammography screening does not reflect this increased risk for older women. Lack of provider recommendation is a major barrier to screening.
  
  
  METHODS
  This is a descriptive study of mammography screening recommendations of community primary care providers in North Carolina (N = 96) participating in a National Cancer Institute funded research project. Providers self-reported screening recommendations for typical patients of different ages and issues and concerns that might influence the decision. Chart reviews compared actual practices with policies stated.
  
  
  RESULTS
  Of the providers, 51% recommended biannual, 45% annual for women ages 50 through 74; 4% recommended biannual, 80% annual, 5% did not recommend screening, and 10% had no general policy for women over 75. Cost, inconsistent guidelines, comorbidity, functional status, value of mammography, and patient resistance influenced screening recommendations. Chart review showed even lower rates of recommendation than self-reported figures.
  
  
  CONCLUSIONS
  Although the use of screening mammography has increased over the past decade, older women are one of the last subgroups to derive benefit from this screening test. Our survey revealed lower rates for mammography referral in older women. The primary care provider appears to be essential to increasing participation for these older women in breast cancer screening.
authors.affiliation: Wake Forest University School of Medicine, Department of Family & Community Medicine, Winston-Salem, NC 27157-1084, USA. psharp@yadtel.net
authors.forename: Penny C
authors.initials: PC
authors.lastname: Sharp
authors.forename: Robert
authors.initials: R
authors.lastname: Michielutte
authors.forename: John G
authors.initials: JG
authors.lastname: Spangler
authors.forename: Louise
authors.initials: L
authors.lastname: Cunningham
authors.forename: Rita
authors.initials: R
authors.lastname: Freimanis
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000517:prevention & control*; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008327:Mammography; D008403:Mass Screening; D008875:Middle Aged; D010819:Physician's Role; D010821:Physicians, Family; D017410:Practice Guidelines as Topic