title: Impact of cognitive impairment on screening mammography use in older US women.
abstract: OBJECTIVE
  We evaluated mammography rates for cognitively impaired women in the context of their life expectancies, given that guidelines do not recommend screening mammography in women with limited life expectancies because harms outweigh benefits.
  
  
  METHODS
  We evaluated Medicare claims for women aged 70 years or older from the 2002 wave of the Health and Retirement Study to determine which women had screening mammography. We calculated population-based estimates of 2-year screening mammography prevalence and 4-year survival by cognitive status and age.
  
  
  RESULTS
  Women with severe cognitive impairment had lower rates of mammography (18%) compared with women with normal cognition (45%). Nationally, an estimated 120,000 screening mammograms were performed among women with severe cognitive impairment despite this group's median survival of 3.3 years (95% confidence interval = 2.8, 3.7). Cognitively impaired women who had high net worth and were married had screening rates approaching 50%.
  
  
  CONCLUSIONS
  Although severe cognitive impairment is associated with lower screening mammography rates, certain subgroups with cognitive impairment are often screened despite lack of probable benefit. Given the limited life expectancy of women with severe cognitive impairment, guidelines should explicitly recommend against screening these women.
authors.affiliation: Division of Geriatrics, University of California, San Francisco, and the San Francisco Veterans Affairs Medical Center, San Francisco, CA 94121, USA. kala.mehta@ucsf.edu
authors.forename: Kala M
authors.initials: KM
authors.lastname: Mehta
authors.forename: Kathy Z
authors.initials: KZ
authors.lastname: Fung
authors.forename: Christine E
authors.initials: CE
authors.lastname: Kistler
authors.forename: Anna
authors.initials: A
authors.lastname: Chang
authors.forename: Louise C
authors.initials: LC
authors.lastname: Walter
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008327:Mammography / Q000706:statistics & numerical data*; D006278:Medicare / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012923:Social Class; D014481:United States / Q000453:epidemiology