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. 2010 Oct;100(10):1917-23.
doi: 10.2105/AJPH.2008.158485. Epub 2010 Jan 14.

Impact of cognitive impairment on screening mammography use in older US women

Kala M Mehta  1 , Kathy Z Fung, Christine E Kistler, Anna Chang, Louise C Walter
Affiliations

Impact of cognitive impairment on screening mammography use in older US women

Kala M Mehta et al. Am J Public Health. 2010 Oct.

Abstract

Objectives: We evaluated mammography rates for cognitively impaired women in the context of their life expectancies, given that guidelines do not recommend screening mammography in women with limited life expectancies because harms outweigh benefits.

Methods: We evaluated Medicare claims for women aged 70 years or older from the 2002 wave of the Health and Retirement Study to determine which women had screening mammography. We calculated population-based estimates of 2-year screening mammography prevalence and 4-year survival by cognitive status and age.

Results: Women with severe cognitive impairment had lower rates of mammography (18%) compared with women with normal cognition (45%). Nationally, an estimated 120,000 screening mammograms were performed among women with severe cognitive impairment despite this group's median survival of 3.3 years (95% confidence interval = 2.8, 3.7). Cognitively impaired women who had high net worth and were married had screening rates approaching 50%.

Conclusions: Although severe cognitive impairment is associated with lower screening mammography rates, certain subgroups with cognitive impairment are often screened despite lack of probable benefit. Given the limited life expectancy of women with severe cognitive impairment, guidelines should explicitly recommend against screening these women.

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Figures

FIGURE 1
FIGURE 1
Screening mammography rates in older US women, by cognitive status and age: Health and Retirement Study, 2002.
FIGURE 2
FIGURE 2
Four-year survival estimates for US women aged 70 years and older, by cognitive status: Health and Retirement Study, 2002.
See this image and copyright information in PMC

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