THE USE OF MAMMOGRAPHY BY WOMEN AGED 75 AND OLDER - FACTORS RELATED TO HEALTH, FUNCTIONING, AND AGE

BACKGROUND AND OBJECTIVES: Mammographic screening for breast cancer is of uncertain clinical benefit for women 75 years of age and older. So me have argued against instituting routine screening in this age group , noting that disability and shorter life expectancy may diminish the desirability and cost-effectiveness of screening. We sought to determi ne the extent to which health, functioning, and age influence mammogra phy use in this cohort. DESIGN, SETTING, AND PARTICIPANTS: A retrospec tive cohort study of a representative sample of women in the US aged 7 5 and older (n = 2352) who participated in the Medicare Current Benefi ciary Survey. MEASURES: Information about general health, level of fun ctioning, medical history, age, and various sociodemographic character istics elicited in the survey was linked with subjects' Medicare bills for 1991 and 1992 to ascertain patterns of mammography use. RESULTS: Overall, 26.7% of the women had mammograms during the 2-year period. A dvanced age was associated with a decreased likelihood of receiving a mammogram. This did not reflect simply the decline in health and funct ioning that may accompany aging; those aged 85 and older were less lik ely to receive mammograms than those in the 75 to 79 age group, contro lling for general health, medical history, functional status, and soci odemographic factors (adjusted OR = .41; 95% CI = 0.27 to 0.64). ADL l imitations were also associated independently with decreased mammograp hy use. For example, controlling for age, women with any limitations i n Activities of Daily Living were 0.71 times as likely to have mammogr ams as women without ADL limitations (95% CI = 0.59 to 0.85). However, several comorbid conditions, including hypertension, diabetes mellitu s, and a history of myocardial infarction were not significantly relat ed to mammography use. CONCLUSIONS: Within the cohort of women aged 75 and older, more advanced age and impaired functional status both subs tantially reduce the likelihood of mammography use. The extent to whic h this reflects patients' informed decisions, physicians' judgments, o r other factors remains to be explored.