title: Utilization of screening mammography in older women according to comorbidity and age: protocol for a systematic review.
abstract: Approximately half of new invasive breast cancer cases diagnosed each year in the United States occur among women aged 65 years and older. The increasing life expectancy coupled with the attendant rise in breast cancer incidence and elimination of out-of-pocket expenses for screening mammography as a result of the Affordable Care Act could lead to higher utilization rates of screening mammography. Although research indicates that life expectancy should be a strong consideration when making screening decisions among older women, the extent to which screening mammography utilization is tailored to comorbidity and life expectancy is not well established.
  
  
  
  To identify relevant studies, a systematic search of the literature will be conducted using PubMed and EMBASE between January 1, 1991, and March 1, 2016. Additional studies will be found through citation review or by contacting experts in the field. The inclusion criteria will be any study design comprised of women aged 65 and older, assessing women's comorbidity, functional impairments, and/or health status, and reporting outcome measures that addressed mammography utilization within the last 1-5 years. For each study, two authors will independently abstract data regarding study eligibility and outcomes to determine relevance. Quantitative results will be extracted from text and tables, choosing preferably those adjusted for important confounders.
  
  
  
  The review will provide evidence on the impact of comorbidity, functional limitations, and health status on screening mammography utilization in older women and inform decision aids in this area.
  
  
  
  PROSPERO CRD42016032661.
authors.affiliation: Department of Epidemiology and Biostatistics, University of California, 550 16th Street, 2nd Floor, Box 0560, San Francisco, CA, 94143, USA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Demb
authors.affiliation: Department of Epidemiology and Biostatistics, University of California, 550 16th Street, 2nd Floor, Box 0560, San Francisco, CA, 94143, USA.
authors.forename: Isabel
authors.initials: I
authors.lastname: Allen
authors.affiliation: Department of Epidemiology and Biostatistics, University of California, 550 16th Street, 2nd Floor, Box 0560, San Francisco, CA, 94143, USA. Dejana.Braithwaite@ucsf.edu.|Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA. Dejana.Braithwaite@ucsf.edu.
authors.forename: Dejana
authors.initials: D
authors.lastname: Braithwaite
mesh_terms: D000367:Age Factors; D001943:Breast Neoplasms / Q000175:diagnosis; D015897:Comorbidity; D055088:Early Detection of Cancer; D005260:Female; D006304:Health Status; D006801:Humans; D008017:Life Expectancy / Q000639:trends; D008327:Mammography / Q000706:statistics & numerical data*; D008403:Mass Screening / Q000379:methods*; D000078202:Systematic Reviews as Topic; D014481:United States
keywords: Aging; Comorbidity; Functional limitations; Health status; Screening mammography; Systematic review