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Julie P. W. Bynum, MD, MPH; Joel B. Braunstein, MD, MBA; Phoebe Sharkey, PhD; Kathleen Haddad, MS; Albert W. Wu, MD, MPH

Arch Intern Med. 2005;165:2083-2088.

Background  Screening mammography is controversial for elderly women because of an absence of efficacy data. Decisions to screen are based on individualized assessment of risks and benefits. Our objective was to determine how screening mammography varies by age and race when adjusted for propensity to die.

Methods  In a retrospective cohort study, rates of screening mammogram performed in 2000-2001 based on claims, adjusted for propensity to die in 2000, were determined for a nationally representative 5% random sample of female fee-for-service Medicare beneficiaries 65 years and older in (N = 722 310).

Results  The overall rate of screening was 39%. When stratified into quintiles by propensity to die, 2-year rates ranged from 61% in the lowest-risk group to 5% in the highest-risk group. In analyses stratified by age and adjusted for propensity to die, 42% of women aged 65 to 69 years were screened, declining to 26% of women 85 years and older (P<.001). Adjusted screening rates for white women, black women, and women of other races were 40%, 30%, and 25%, respectively (P<.001). Thus, among women with similar health status, the youngest women were 1.61 times more likely to be screened compared with the oldest; compared with black women and women of other races, white women were 1.38 and 1.60 times, respectively, more likely to be screened.

Conclusions  Decisions to screen for breast cancer are related not only to health status but also to age and race. Underuse and overuse of screening mammography likely occurs owing to age- and race-associated decision making. Assessment of life expectancy may more accurately identify women who could benefit from screening.

Author Affiliations: Department of Internal Medicine and Center for the Evaluative Clinical Sciences, Dartmouth Medical School, Hanover, NH (Dr Bynum); Division of Cardiology, School of Medicine (Dr Braunstein) and Department of Health Policy and Management, Bloomberg School of Public Health (Ms Haddad and Dr Wu), Johns Hopkins University, Baltimore, Md; and Department of Information Systems and Operations Management, Sellinger School of Business, Loyola College in Maryland, Baltimore (Dr Sharkey).

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