Relationship between health status and use of screening mammography and Papanicolaou smears among women older than 70 years of age

Abstract

Background: 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.

Objective: To determine whether screening mammography and Pap smears are targeted to healthy older women and are avoided in women with limited life expectancies.

Design: Cross-sectional population-based study.

Setting: California.

Patients: 4792 women 70 years of age or older who participated in the California Health Interview Survey between November 2000 and October 2001.

Measurements: 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.

Results: 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.

Limitations: This study relied on self-report, and the interview response rate was 63.7%.

Conclusions: 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.