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Screening mammography: Is it suitably targeted to older women who are most likely to benefit?
J D Scinto1, T M Gill, J N Grady
1Qualidigm (formerly CPRO), Middletown, Connecticut, USA.
Objectives:
To determine whether screening mammography is suitably targeted to older women who are most likely to benefit.
Design:
Prospective cohort study.
Setting:
New Haven County, Connecticut.
Participants:
Eight hundred forty-four community-dwelling older women were interviewed as part of the 1990 New Haven Established Populations for the Epidemiologic Study of the Elderly (EPESE) program.
Measurements:
Mammography use was ascertained from Medicare Part B claims data. A four-level prognostic mortality index was developed using items previously shown to be predictive of mortality. Mammography use and all-cause mortality were evaluated by prognostic stage over a 5-year period, January 1, 1991, to December 31, 1995.
Results:
Five-year mortality increased steadily with each prognostic stage (12% to 68%, P = .001), whereas the 5-year mammography use rate declined (48% to 7%, P = .001). Over half the women (53%) in the most favorable prognostic group did not receive a mammogram, whereas 13% in the two worst prognostic groups received at least one mammogram.
Conclusion:
Screening mammography may be underutilized among older women who are the most likely to benefit and overutilized among those who are unlikely to benefit.
