Reduced mammographic screening may explain declines in breast carcinoma in older women.
OBJECTIVE
To examine whether declines in breast cancer in the oldest-old women correspond with declines in the use of cancer testing.


METHODS
Cross-sectional evaluation of three databases.


METHODS
Public access data.


METHODS
Cases recorded in the California Registry and the Surveillance, Epidemiology, and End Results Program between 1988 and 1997. The study also included respondents to the 2002 Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System.


METHODS
Cancer incidence and self-reported mammography within the previous 2 years.


RESULTS
Most previous analyses have combined all individuals aged 75, 80, or 85 and older. Creating separate categories for age ranges 85 to 89, 90 to 94, 95 to 99, and 100 and older suggests different incidence patterns for a variety of cancers, including mammary carcinoma in situ (CIS). Between the ages of 40 and 74, there is a significant rise in CIS. Beginning at age 75, there is a significant decline in CIS through the highest age categories. The use of mammographic screening increases between the ages of 40 and 60. Beginning at age 75, there is a significant decline in the use of mammography that parallels the decline in incident cases of CIS.


CONCLUSIONS
There may be a substantial reservoir of undiagnosed CIS in the population. Surveillance bias might explain the decreasing incidence of CIS with advancing age in the oldest age groups. Autopsy studies are needed to estimate the true prevalence of CIS in older women.
Kaplan
Robert M
RM
Department of Health Services, University of California at Los Angeles School of Public Health, Los Angeles, California 90095, USA. rmkaplan@ucla.edu
Saltzstein
Sidney L
SL
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000453:epidemiology*; D002278:Carcinoma in Situ / Q000453:epidemiology; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data*; D008875:Middle Aged; D012307:Risk Factors; D014481:United States / Q000453:epidemiology