Screening mammography: Is it suitably targeted to older women who are mostlikely to benefit?

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 E pidemiologic Study of the Elderly (EPESE) program. MEASUREMENTS: Mammography use was ascertained from Medicare Part B claims d ata. A four-level prognostic mortality index was developed using items prev iously shown to be predictive of mortality. Mammography use and all-cause m ortality 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 (4 8% to 7%, P = .001). Over half the women (53%) in the most favorable progno stic group did not receive a mammogram, whereas 13% in the two worst progno stic groups received at least one mammogram. CONCLUSION: Screening mammography may be underutilized among older women wh o are the most likely to benefit and overutilized among those who are unlik ely to benefit.