title: Mammography Screening Among the Elderly: A Research Challenge.
abstract: BACKGROUND
  Randomized trials demonstrate clear benefits of mammography screening in women through age 74 years. We explored age- and race-specific rates of mammography screening and breast cancer mortality among women aged 69 to 84 years.
  
  
  METHODS
  We analyzed Medicare claims data for women residing within Surveillance, Epidemiology and End Results geographic areas from 1995 to 2009 from 64,384 non-Hispanic women (4886 black and 59,498 white) and ascertained all primary breast cancer cases diagnosed between ages 69 and 84 years. The exposure was annual or biennial screening mammography during the 4 years immediately preceding diagnosis. The outcome was breast cancer mortality during the 10 years immediately after diagnosis.
  
  
  RESULTS
  After adjustment for stage at diagnosis, radiation therapy, chemotherapy, comorbid conditions, and contextual socioeconomic status, hazard ratios (and 95% confidence intervals) for breast cancer mortality relative to no/irregular mammography at 10 years for women aged 69 to 84 years at diagnosis were 0.31 (0.29-0.33) for annual mammography and 0.47 (0.44-0.51) for biennial mammography among whites and 0.36 (0.29-0.44) for annual mammography and 0.47 (0.37-0.58) for biennial mammography among blacks. Trends were similar at 5 years overall and stratified by ages 69 to 74 years, 75 to 78 years, and 79 to 84 years.
  
  
  CONCLUSIONS
  In these Medicare claims and Surveillance, Epidemiology and End Results data, elderly non-Hispanic women who self-selected for annual mammography had lower 10-year breast cancer mortality than corresponding women who self-selected for biennial or no/irregular mammography. These findings were similar among black and white women. The data highlight the evidentiary limitations of data used for current screening mammography recommendations.
authors.affiliation: Department of Family and Community Medicine, Meharry Medical College, Nashville, Tenn. Electronic address: msanderson@mmc.edu.
authors.forename: Maureen
authors.initials: M
authors.lastname: Sanderson
authors.affiliation: Department of Family and Community Medicine, Meharry Medical College, Nashville, Tenn.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Levine
authors.affiliation: Department of Family and Community Medicine, Meharry Medical College, Nashville, Tenn.
authors.forename: Mary K
authors.initials: MK
authors.lastname: Fadden
authors.affiliation: Department of Family and Community Medicine, Meharry Medical College, Nashville, Tenn.
authors.forename: Barbara
authors.initials: B
authors.lastname: Kilbourne
authors.affiliation: Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham.
authors.forename: Maria
authors.initials: M
authors.lastname: Pisu
authors.affiliation: Center for Health Research, Tennessee State University, Nashville.
authors.forename: Van
authors.initials: V
authors.lastname: Cain
authors.affiliation: Center for Health Research, Tennessee State University, Nashville.
authors.forename: Baqar A
authors.initials: BA
authors.lastname: Husaini
authors.affiliation: Department of Electrical Engineering and Computer Science, University of Tennessee, Knoxville.
authors.forename: Michael
authors.initials: M
authors.lastname: Langston
authors.affiliation: Department of Political Science, Texas Tech University, Lubbock.
authors.forename: Lisa
authors.initials: L
authors.lastname: Gittner
authors.affiliation: Department of Family and Community Medicine, Meharry Medical College, Nashville, Tenn.
authors.forename: Roger
authors.initials: R
authors.lastname: Zoorob
authors.affiliation: Morehouse School of Medicine, National Center for Primary Care, Atlanta, Ga.
authors.forename: George S
authors.initials: GS
authors.lastname: Rust
authors.affiliation: Department of Family and Community Medicine, Meharry Medical College, Nashville, Tenn; Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton.
authors.forename: Charles H
authors.initials: CH
authors.lastname: Hennekens
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D044383:Black People / Q000706:statistics & numerical data; D001943:Breast Neoplasms / Q000401:mortality; D005260:Female; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data; D044465:White People / Q000706:statistics & numerical data
keywords: Breast cancer screening; Geographic disparities; Mortality; Racial disparity