RESPONSE OF WOMEN AGED 65-74 TO INVITATION FOR SCREENING FOR BREAST-CANCER BY MAMMOGRAPHY - A PILOT-STUDY IN LONDON, UK

Objective - To investigate the response and benefits to be gained from mammographic screening for breast cancer in women aged 65-74, who are not normally invited for screening. Design - This was a pilot study c omprising women aged 65-74 who are not currently invited for routine s creening under the NHS breast screening programme. The results from th is study were compared with the results of routinely screened women (a ged 50-64) from the same health district. Setting - A mobile breast sc reening unit in the grounds of the Royal Free Hospital. Subjects - The se comprised 5004 women aged 65-74 registered with GPs in the district of Hampstead and on the family health services authority (FHSA) lists . A total of 168 (3.4%) were initially excluded by the general practit ioner or FHSA, and 286 (5.9%) of the invitation letters were returned by the Post Office or by other people as not deliverable for some reas on. Main outcome measures - Response rates to the invitation were asse ssed using three indices: crude population coverage rate, crude invite d population coverage rate, and corrected invited population coverage rate. Results - With regard to response rates, 16-84 women aged 65-74 (37% of all those invited, excluding those who were not available) wer e screened, compared with 2894 (42%) women aged 50-64. The three respo nse rates were higher for younger women than older: the crude populati on coverage rate was 37.1%, the crude invited population coverage rate was 38.9%, and the corrected invited population coverage rate was 42. 1% for women aged 5064, compared with 32.9%, 34.4%, and 36.8% respecti vely for women aged 65-69 and 34.3%, 35.2%, and 37.2% for women aged 7 0-74. The rate of assessment increased significantly with increasing a ge, with 3.18% of the 50-64 population screened being assessed, as com pared with 4.14% and 4.83% of the women aged 65-69 and 70-74, respecti vely. Most biopsies done in the older women gave positive results, as did the biopsies from the 50-64 age group. However, the biopsy rate in creased significantly with increasing age. The cancer detection rates in the women aged 65-69 and 70-74 were 14 2/1000 and compared with an incident round rate of 4.5/1000 in women aged 50-64. Conclusions - The se results show that there is potential for similar attendance at rout ine screening by older women if they are invited in the same way as yo unger women. As the assessment, biopsy, and cancer detection rates in the older women are significantly higher than in the 50-64 year olds, the costs and benefits of including them in the NHS screening programm e should be reassessed.