Background
Most studies use age as a cutoff to evaluate screening mammography utilization, generally
examining screening up to age 75 years (the age-cutoff method). However, many experts
and guidelines encourage clinicians to consider patient health and/or life expectancy.
Purpose
To compare the accuracy of estimating screening mammography utilization in older women
using the age-cutoff method versus using a method based on the projected life expectancy.
Methods
Two cohorts were selected from female Medicare beneficiaries aged 67–90 years living
in Texas in 2001 and 2006. The 2001 cohort (n=716,279) was used to generate life-expectancy estimates by age and comorbidity, which
were then applied to the 2006 cohort (n=697,825). Screening mammography utilization during 2006–2007 was measured for the
2006 cohort. Data were collected in 2000–2007 and analyzed in 2011.
Results
The screening rate was 52.7% in women aged 67–74 years based on age alone, compared
to 53.5% in women in the same age group with a life expectancy of ≥7 years. A large
proportion (63.4%) of women aged 75–90 years (n=370,583) had a life expectancy of ≥7 years. Those women had a screening rate of 42.7%.
The screening rate was 35.7% in women aged 75–90 years based on age alone, compared
to 16.3% in women in the same age group with a life expectancy of <5 years.
Conclusions
Estimating screening mammography utilization among older women can be improved by
using projected life expectancy rather than the age-cutoff method.
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