title: Targeting of mammography screening according to life expectancy in women aged 75 and older.
abstract: OBJECTIVE
  To examine receipt of mammography screening according to life expectancy in women aged 75 and older.
  
  
  METHODS
  Population-based survey.
  
  
  METHODS
  United States.
  
  
  METHODS
  Community dwelling U.S. women aged 75 and older who participated in the 2008 or 2010 National Health Interview Survey.
  
  
  METHODS
  Using a previously developed and validated index, women were categorized according to life expectancy (>9, 5-9, <5 years). Receipt of mammography screening in the past 2 years was examined according to life expectancy, adjusting for sociodemographic characteristics, access to care, preventive orientation (e.g., receipt of influenza vaccination), and receipt of a clinician recommendation for screening.
  
  
  RESULTS
  Of 2,266 respondents, 27.1% had a life expectancy of greater than 9 years, 53.4% had a life expectancy of 5 to 9 years, and 19.5% had a life expectancy of less than 5 years. Overall, 55.7% reported receiving mammography screening in the past 2 years. Life expectancy was strongly associated with receipt of screening (P < .001), yet 36.1% of women with less than 5 years life expectancy were screened, and 29.2% of women with more than 9 years life expectancy were not screened. A clinician recommendation for screening was the strongest predictor of screening independent of life expectancy. Higher educational attainment, age, receipt of influenza vaccination, and history of benign breast biopsy were also independently associated with being screened.
  
  
  CONCLUSIONS
  Despite uncertainty of benefit, many women aged 75 and older are screened with mammography. Life expectancy is strongly associated with receipt of screening, which may reflect clinicians and patients appropriately considering life expectancy in screening decisions, but 36% of women with short life expectancies are still screened, suggesting that new interventions are needed to further improve targeting of screening according to life expectancy. Decision aids and guidelines encouraging clinicians to consider patient life expectancy in screening decisions may improve care.
authors: Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA 02446, USA. mschonbe@bidmc.harvard.edu
authors: Mara A
authors: MA
authors: Schonberg
authors: Erica S
authors: ES
authors: Breslau
authors: Ellen P
authors: EP
authors: McCarthy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006306:Health Surveys; D006801:Humans; D008017:Life Expectancy; D008327:Mammography / Q000706:statistics & numerical data*; D008403:Mass Screening / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D014481:United States