Screening mammography in the elderly

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Abstract
This case—control study tested the hypothesis that elderly women with metastatic breast cancer were previously screened less than controls. Cases included women over 60 years old who had metastatic breast cancer; the tumor registry provided controls. Identical criteria yielded comparable groups (cases=109, controls=211) receiving primary care at this tertiary center. Radiology and medical records were examined for mammograms; these were blindly categorized “diagnostic,” “screening,” or “indeterminant.” The major, unexpected finding was that less than 6% of controls had ever had screening mammography. The associations between screening and metastatic cancer (odds ratios) suggest a beneficial effect of screening: OR/0.73 for ever screened and OR/0.71 if screened within the year of cancer diagnosis. All confidence intervals include one; however, low screening participation leaves this study with little power. The major implication is that despite the current recommendations, the elderly are not being included in screening mammography programs.