Louise C. Walter, MD; Karla Lindquist, MS; Kenneth E. Covinsky, MD, MPH
Grant Support: Dr. Walter is a recipient of the Veterans Administration Research Career Development Award from the Division of Health Services Research and Development. Dr. Covinsky was supported in part by an independent investigator award from the Agency for Healthcare Research and Quality (K02HS000006-02) and is a Paul Beeson Faculty Scholar in Aging Research.
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Louise C. Walter, MD, Division of Geriatrics, Veterans Affairs Medical Center 181G, 4150 Clement Street, San Francisco, CA 94121; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. Walter and Covinsky and Ms. Lindquist: Division of Geriatrics, Veterans Affairs Medical Center 181G, 4150 Clement Street, San Francisco, CA 94121.
Author Contributions: Conception and design: L.C. Walter, K.E. Covinsky.
Analysis and interpretation of the data: L.C. Walter, K. Lindquist, K.E. Covinsky.
Drafting of the article: L.C. Walter.
Critical revision of the article for important intellectual content: L.C. Walter, K. Lindquist, K.E. Covinsky.
Final approval of the article: L.C. Walter, K.E. Covinsky.
Statistical expertise: K. Lindquist, K.E. Covinsky.
Older women whose life expectancy is less than 5 years are unlikely to benefit from screening mammography or Papanicolaou (Pap) smears. Since life expectancy is better predicted by health status than by age alone, guidelines recommend considering an older woman's general health when making screening decisions.
To determine whether screening mammography and Pap smears are targeted to healthy older women and are avoided in women with limited life expectancies.
Cross-sectional population-based study.
4792 women 70 years of age or older who participated in the California Health Interview Survey between November 2000 and October 2001.
Predictor variables included age and health status. Health status was measured by using the Medical Outcomes Study 12-item Short Form Physical Summary Scale. The main outcome was self-reported receipt of screening mammography within the previous 2 years and a screening Pap smear within 3 years.
Seventy-eight percent of women reported recent screening mammography, and 77% reported a recent Pap smear. Screening rates decreased with advancing age. However, within each age group, the percentage of women reporting screening did not significantly decrease with worsening health status (P > 0.1 for all comparisons). More than half of women 80 years of age or older in the worst health quartile reported recent screening, representing approximately 81 000 mammograms and 35 000 Pap smears.
This study relied on self-report, and the interview response rate was 63.7%.
Rates of recent screening mammography and Pap smears are high among older women in California. Although screening rates drop with advancing age, women in poor health do not avoid screening. Screening should be better targeted to healthy older women and should be avoided in women with limited life expectancies for whom risks of screening outweigh potential benefits.
Some worry that clinicians will screen for breast and cervical cancer even when the probability of benefit is very low because of the patient's age and comorbid disease.
Over 75% of women age 70 years or older reported recent mammography and Papanicolaou smear in a 2000–2001 health survey. Rates decreased with age but not with worsening self-reported health status.
Decisions to screen for breast and cervical cancer may not appropriately consider an individual woman's health.
The researchers used self-reported health, which correlates with life expectancy in populations but may not be accurate enough to use in individual patients.
Flow diagram of women included in analyses for each screening test.Pap
Table 1. Characteristics of California Women 70 Years of Age or Older, according to Health Status (n = 4792)
Women in California who reported receiving screening mammography within 2 years, according to health status and age (n= 3988).
Table 2. Multivariate Analysis: Relation of Age and Health Status to Use of Screening Mammography and Papanicolaou Smears among California Women 70 Years of Age or Older
Women in California who reported a screening Papanicolaou (Pap) smear within 3 years, according to health status and age (n= 2143).
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Walter LC, Lindquist K, Covinsky KE. Relationship between Health Status and Use of Screening Mammography and Papanicolaou Smears among Women Older Than 70 Years of Age. Ann Intern Med. 2004;140:681-688. doi: 10.7326/0003-4819-140-9-200405040-00007
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Published: Ann Intern Med. 2004;140(9):681-688.
Breast Cancer, Cancer Screening/Prevention, Hematology/Oncology, Prevention/Screening.
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