BARRIERS TO BREAST-CANCER SCREENING IN OLDER WOMEN

As health care reform unfolds over the next several years, nurse-midwi ves will be increasingly addressing issues of health care in women of all ages across the life span. For older women, a prevalent condition that has received minimal attention in this age group has been breast cancer. Distinctions have been noted in the literature between older a nd younger women in terms of the biology, screening, and treatment of breast cancer. Despite theories that breast tumors in older individual s are more indolent and slower growing than those found in younger wom en, older women's mortality from breast cancer is higher. Although par t of this is theorized to be due to other biologic processes, such as increased immune suppression with aging, it appears that most of the d istinction between the courses of breast cancer in older and younger i ndividuals has been related to decreased screening during advanced age . This manuscript describes the individual client, health care provide r, and health care system barriers to each of the three major elements of breast cancer screening-breast self-examination, clinical breast e xamination, and mammography. Suggestions and caveats including ethical , legal, and political issues regarding breast cancer screening in old er women are presented.