1
|
Dickson-Swift V, Adams J, Spelten E, Blackberry I, Wilson C, Yuen E. Breast cancer screening motivation and behaviours of women aged over 75 years: a scoping review. BMC Womens Health 2024; 24:256. [PMID: 38658945 PMCID: PMC11040767 DOI: 10.1186/s12905-024-03094-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 04/15/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND This scoping review aimed to identify and present the evidence describing key motivations for breast cancer screening among women aged ≥ 75 years. Few of the internationally available guidelines recommend continued biennial screening for this age group. Some suggest ongoing screening is unnecessary or should be determined on individual health status and life expectancy. Recent research has shown that despite recommendations regarding screening, older women continue to hold positive attitudes to breast screening and participate when the opportunity is available. METHODS All original research articles that address motivation, intention and/or participation in screening for breast cancer among women aged ≥ 75 years were considered for inclusion. These included articles reporting on women who use public and private breast cancer screening services and those who do not use screening services (i.e., non-screeners). The Joanna Briggs Institute (JBI) methodology for scoping reviews was used to guide this review. A comprehensive search strategy was developed with the assistance of a specialist librarian to access selected databases including: the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, Web of Science and PsychInfo. The review was restricted to original research studies published since 2009, available in English and focusing on high-income countries (as defined by the World Bank). Title and abstract screening, followed by an assessment of full-text studies against the inclusion criteria was completed by at least two reviewers. Data relating to key motivations, screening intention and behaviour were extracted, and a thematic analysis of study findings undertaken. RESULTS A total of fourteen (14) studies were included in the review. Thematic analysis resulted in identification of three themes from included studies highlighting that decisions about screening were influenced by: knowledge of the benefits and harms of screening and their relationship to age; underlying attitudes to the importance of cancer screening in women's lives; and use of decision aids to improve knowledge and guide decision-making. CONCLUSION The results of this review provide a comprehensive overview of current knowledge regarding the motivations and screening behaviour of older women about breast cancer screening which may inform policy development.
Collapse
Affiliation(s)
- Virginia Dickson-Swift
- Violet Vines Centre for Rural Health Research, La Trobe Rural Health School, La Trobe University, P.O. Box 199, Bendigo, VIC, 3552, Australia
| | - Joanne Adams
- Violet Vines Centre for Rural Health Research, La Trobe Rural Health School, La Trobe University, P.O. Box 199, Bendigo, VIC, 3552, Australia.
| | - Evelien Spelten
- Violet Vines Centre for Rural Health Research, La Trobe Rural Health School, La Trobe University, P.O. Box 199, Bendigo, VIC, 3552, Australia
| | - Irene Blackberry
- Care Economy Research Institute, La Trobe University, Wodonga, Australia
| | - Carlene Wilson
- Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Melbourne, Australia
- Melbourne School of Population and Global Health, Melbourne University, Melbourne, Australia
- School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Eva Yuen
- Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Melbourne, Australia
- Institute for Health Transformation, Deakin University, Burwood, Australia
- Centre for Quality and Patient Safety, Monash Health Partnership, Monash Health, Clayton, Australia
- School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| |
Collapse
|
2
|
Braithwaite D, Chicaiza A, Lopez K, Lin KW, Mishori R, Karanth SD, Anton S, Miller K, Schonberg MA, Schoenborn NL, O’Neill SC. Clinician and patient perspectives on screening mammography among women age 75 and older: A pilot study of a novel decision aid. PEC INNOVATION 2023; 2:100132. [PMID: 37124453 PMCID: PMC10136373 DOI: 10.1016/j.pecinn.2023.100132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Objective Supporting patient-clinician communication is key to implementing tailored, risk-based screening for older adults. Objectives of this multiphase mixed methods study were to identify factors that primary care clinicians consider influential when making screening mammography recommendations for women ≥ 75 years, develop a patient decision aid that incorporates these factors, and gather feasibility and acceptability from the patients' perspective. Methods Clinicians from a Mid-Atlantic practice network completed online surveys. Women in the same network completed surveys before and after receiving a tailored booklet that included information about the benefits and harms of screening for women ≥ 75 years, a breast cancer risk-estimate, and a question prompt list to support patient-clinician communication. Results Clinicians (N = 21) were primarily women [57.1%] and practiced family medicine [81.0%]. They cited patients' age ≥ 75 years [95.4%], comorbidity [86.4%], functional status [77.3%], cancer family history [63.6%], U.S. Preventive Services Task Force guidelines [81.8%] and new research [77.3%] as factors influencing their recommendations. Fourteen women completed baseline surveys and received personalized decision aids (Mean age = 79.1 years). Eleven completed the post-intervention survey. All were satisfied with the booklet length, 81.8% found the booklet easy to understand and 72.7% helpful in decision-making Perceived lifetime breast cancer risk decreased significantly from pre- to post-intervention (p = 0.02). Conclusions Results suggest this decision aid, which incorporates key decisional factors from the clinician's perspective, is feasible and acceptable to patients. Innovation A tailored decision aid booklet is innovative as it provides information on personalized risk and potential benefits and harms to older women considering screening.
Collapse
Affiliation(s)
- Dejana Braithwaite
- University of Florida Health Cancer Center, Gainesville, FL, United States of America
- Corresponding author at: University of Florida Health Cancer Center, University of Florida, Clinical and Translational Research Building, 2004 Mowry Road, Gainesville, FL 32610, United States of America. (D. Braithwaite)
| | - Anthony Chicaiza
- Georgetown University Medical Center, Washington, DC, United States of America
| | - Katherine Lopez
- Georgetown University Medical Center, Washington, DC, United States of America
| | - Kenneth W. Lin
- Georgetown University Medical Center, Washington, DC, United States of America
| | - Ranit Mishori
- Georgetown University Medical Center, Washington, DC, United States of America
| | - Shama D. Karanth
- University of Florida Health Cancer Center, Gainesville, FL, United States of America
| | - Stephen Anton
- University of Florida Health Cancer Center, Gainesville, FL, United States of America
| | - Kristen Miller
- Georgetown University Medical Center, Washington, DC, United States of America
- National Center for Human Factors in Healthcare, MedStar Health Research Institute, Washington, DC, United States of America
| | - Mara A. Schonberg
- Dana Farber Cancer Center, Harvard University, Boston, MA, United States of America
| | - Nancy L. Schoenborn
- Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Suzanne C. O’Neill
- Georgetown University Medical Center, Washington, DC, United States of America
| |
Collapse
|
3
|
Lee CS, Lewin A, Reig B, Heacock L, Gao Y, Heller S, Moy L. Women 75 Years Old or Older: To Screen or Not to Screen? Radiographics 2023; 43:e220166. [PMID: 37053102 DOI: 10.1148/rg.220166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
Breast cancer is the most common cancer in women, with the incidence rising substantially with age. Older women are a vulnerable population at increased risk of developing and dying from breast cancer. However, women aged 75 years and older were excluded from all randomized controlled screening trials, so the best available data regarding screening benefits and risks in this age group are from observational studies and modeling predictions. Benefits of screening in older women are the same as those in younger women: early detection of smaller lower-stage cancers, resulting in less invasive treatment and lower morbidity and mortality. Mammography performs significantly better in older women with higher sensitivity, specificity, cancer detection rate, and positive predictive values, accompanied by lower recall rates and false positives. The overdiagnosis rate is low, with benefits outweighing risks until age 90 years. Although there are conflicting national and international guidelines about whether to continue screening mammography in women beyond age 74 years, clinicians can use shared decision making to help women make decisions about screening and fully engage them in the screening process. For women aged 75 years and older in good health, continuing annual screening mammography will save the most lives. An informed discussion of the benefits and risks of screening mammography in older women needs to include each woman's individual values, overall health status, and comorbidities. This article will review the benefits, risks, and controversies surrounding screening mammography in women 75 years old and older and compare the current recommendations for screening this population from national and international professional organizations. ©RSNA, 2023 Quiz questions for this article are available through the Online Learning Center.
Collapse
Affiliation(s)
- Cindy S Lee
- From the Department of Radiology, NYU Langone Health, New York, NY (C.S.L., A.L., B.R., L.H., Y.G., S.H., L.M.); and Center for Advanced Imaging Innovation and Research, Vilcek Institute of Graduate Biomedical Sciences, New York, NY (L.M.)
| | - Alana Lewin
- From the Department of Radiology, NYU Langone Health, New York, NY (C.S.L., A.L., B.R., L.H., Y.G., S.H., L.M.); and Center for Advanced Imaging Innovation and Research, Vilcek Institute of Graduate Biomedical Sciences, New York, NY (L.M.)
| | - Beatriu Reig
- From the Department of Radiology, NYU Langone Health, New York, NY (C.S.L., A.L., B.R., L.H., Y.G., S.H., L.M.); and Center for Advanced Imaging Innovation and Research, Vilcek Institute of Graduate Biomedical Sciences, New York, NY (L.M.)
| | - Laura Heacock
- From the Department of Radiology, NYU Langone Health, New York, NY (C.S.L., A.L., B.R., L.H., Y.G., S.H., L.M.); and Center for Advanced Imaging Innovation and Research, Vilcek Institute of Graduate Biomedical Sciences, New York, NY (L.M.)
| | - Yiming Gao
- From the Department of Radiology, NYU Langone Health, New York, NY (C.S.L., A.L., B.R., L.H., Y.G., S.H., L.M.); and Center for Advanced Imaging Innovation and Research, Vilcek Institute of Graduate Biomedical Sciences, New York, NY (L.M.)
| | - Samantha Heller
- From the Department of Radiology, NYU Langone Health, New York, NY (C.S.L., A.L., B.R., L.H., Y.G., S.H., L.M.); and Center for Advanced Imaging Innovation and Research, Vilcek Institute of Graduate Biomedical Sciences, New York, NY (L.M.)
| | - Linda Moy
- From the Department of Radiology, NYU Langone Health, New York, NY (C.S.L., A.L., B.R., L.H., Y.G., S.H., L.M.); and Center for Advanced Imaging Innovation and Research, Vilcek Institute of Graduate Biomedical Sciences, New York, NY (L.M.)
| |
Collapse
|
4
|
Advani SM, Zhu W, Demb J, Sprague BL, Onega T, Henderson LM, Buist DSM, Zhang D, Schousboe JT, Walter LC, Kerlikowske K, Miglioretti DL, Braithwaite D. Association of Breast Density With Breast Cancer Risk Among Women Aged 65 Years or Older by Age Group and Body Mass Index. JAMA Netw Open 2021; 4:e2122810. [PMID: 34436608 PMCID: PMC8391100 DOI: 10.1001/jamanetworkopen.2021.22810] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
IMPORTANCE Breast density is associated with breast cancer risk in women aged 40 to 65 years, but there is limited evidence of its association with risk of breast cancer among women aged 65 years or older. OBJECTIVE To compare the association between breast density and risk of invasive breast cancer among women aged 65 to 74 years vs women aged 75 years or older and to evaluate whether the association is modified by body mass index (BMI). DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study used data from the Breast Cancer Surveillance Consortium from January 1, 1996, to December 31, 2012, for US women aged 65 years or older who underwent screening mammography. Data were analyzed from January 1, 2018, to December 31, 2020. EXPOSURES Breast Imaging Reporting and Data System breast density category, age, and BMI. MAIN OUTCOMES AND MEASURES The 5-year cumulative incidence of invasive breast cancer by level of breast density (almost entirely fat, scattered fibroglandular densities, or heterogeneous or extreme density) and age (65-74 vs ≥75 years) was calculated using weighted means. Cox proportional hazards models were fit to estimate the association of breast density with invasive breast cancer risk. The likelihood ratio test was used to test the interaction between BMI and breast density. RESULTS A total of 221 714 screening mammograms from 193 787 women were included in the study; a total of 38% of the study population was aged 75 years or older. Of the mammograms, most were from women aged 65 to 74 years (64.6%) and non-Hispanic White individuals (81.4%). The 5-year cumulative incidence of invasive breast cancer increased in association with increasing breast density among women aged 65 to 74 years (almost entirely fatty breasts: 11.3 per 1000 women [95% CI, 10.4-12.5 per 1000 women]; scattered fibroglandular densities: 17.2 per 1000 women [95% CI, 16.1-17.9 per 1000 women]; extremely or heterogeneously dense breasts: 23.7 per 1000 women [95% CI, 22.4-25.3 per 1000 women]) and among those aged 75 years or older (fatty breasts: 13.5 per 1000 women [95% CI, 11.6-15.5]; scattered fibroglandular densities: 18.4 per 1000 women [95% CI, 17.0-19.5 per 1000 women]; extremely or heterogeneously dense breasts: 22.5 per 1000 women [95% CI, 20.2-24.2 per 1000 women]). Extreme or heterogeneous breast density was associated with increased risk of breast cancer compared with scattered fibroglandular breast density in both age categories (65-74 years: hazard ratio [HR], 1.39 [95% CI, 1.28-1.50]; ≥75 years: HR, 1.23 [95% CI, 1.10-1.37]). Women with almost entirely fatty breasts had a decrease of approximately 30% (range, 27%-34%) in the risk of invasive breast cancer compared with women with scattered fibroglandular breast density (65-74 years: HR, 0.66 [95% CI, 0.58-0.75]; ≥75 years: HR, 0.73; 95% CI, 0.62-0.86). Associations between breast density and breast cancer risk were not significantly modified by BMI (for age 65-74 years: likelihood ratio test, 2.67; df, 2; P = .26; for age ≥75 years, 2.06; df, 2; P = .36). CONCLUSIONS AND RELEVANCE The findings suggest that breast density is associated with increased risk of invasive breast cancer among women aged 65 years or older. Breast density and life expectancy should be considered together when discussing the potential benefits vs harms of continued screening mammography in this population.
Collapse
Affiliation(s)
- Shailesh M. Advani
- Department of Oncology, Georgetown University, Washington, DC
- Terasaki Institute of Biomedical Innovation, Los Angeles, California
| | - Weiwei Zhu
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Joshua Demb
- Department of Medicine, University of California, San Diego
| | - Brian L. Sprague
- Department of Surgery, Larner College of Medicine, University of Vermont, Burlington
| | - Tracy Onega
- Department of Population Sciences, University of Utah, Salt Lake City
| | | | - Diana S. M. Buist
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Dongyu Zhang
- Department of Epidemiology, University of Florida, Gainesville
| | - John T. Schousboe
- Division of Research, Health Partners Institute, Bloomington, Minnesota
| | | | - Karla Kerlikowske
- Department of Medicine, University of California, San Francisco
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Diana L. Miglioretti
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
- Department of Public Health Sciences, School of Medicine, University of California, Davis
| | - Dejana Braithwaite
- Terasaki Institute of Biomedical Innovation, Los Angeles, California
- Cancer Control and Population Sciences Program, University of Florida Health Cancer Center, Gainesville
- Department of Epidemiology, University of Florida, Gainesville
| |
Collapse
|
5
|
Austin JD, Shelton RC, Lee Argov EJ, Tehranifar P. Older Women’s Perspectives Driving Mammography Screening Use and Overuse: a Narrative Review of Mixed-Methods Studies. CURR EPIDEMIOL REP 2020. [DOI: 10.1007/s40471-020-00244-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Abstract
Purpose of Review
Examining what older women know and perceive about mammography screening is critical for understanding patterns of under- and overuse, and concordance with screening mammography guidelines in the USA. This narrative review synthesizes qualitative and quantitative evidence around older women’s perspectives toward mammography screening.
Recent Findings
The majority of 43 identified studies focused on promoting mammography screening in women of different ages, with only four studies focusing on the overuse of mammography in women ≥ 70 years old. Older women hold positive attitudes around screening, perceive breast cancer as serious, believe the benefits outweigh the barriers, and are worried about undergoing treatment if diagnosed. Older women have limited knowledge of screening guidelines and potential harms of screening.
Summary
Efforts to address inequities in mammography access and underuse need to be supplemented by epidemiologic and interventional studies using mixed-methods approaches to improve awareness of benefits and harms of mammography screening in older racially and ethnically diverse women. As uncertainty around how best to approach mammography screening in older women remains, understanding women’s perspectives along with healthcare provider and system-level factors is critical for ensuring appropriate and equitable mammography screening use in older women.
Collapse
|
6
|
Austin AM, Kapadia NS, Brooks GA, Onega TL, Eliassen AH, Tamimi RM, Holmes M, Wang Q, Grodstein F, Tosteson ANA. Comparison of treatment of early-stage breast cancer among Nurses' Health Study participants and other Medicare beneficiaries. Breast Cancer Res Treat 2019; 174:759-767. [PMID: 30607634 DOI: 10.1007/s10549-018-05098-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 12/12/2018] [Indexed: 01/02/2023]
Abstract
PURPOSE Increasingly epidemiological cohorts are being linked to claims data to provide rich data for healthcare research. These cohorts tend to be different than the general United States (US) population. We will analyze healthcare utilization of Nurses' Health Study (NHS) participants to determine if studies of newly diagnosed incident early-stage breast cancer can be generalized to the broader US Medicare population. METHODS Analytic cohorts of fee-for-service NHS-Medicare-linked participants and a 1:13 propensity-matched SEER-Medicare cohort (SEER) with incident breast cancer in the years 2007-2011 were considered. Screening leading to, treatment-related, and general utilization in the year following early-stage breast cancer diagnosis were determined using Medicare claims data. RESULTS After propensity matching, NHS and SEER were statistically balanced on all demographics. NHS and SEER had statistically similar rates of treatments including chemotherapy, breast-conserving surgery, mastectomy, and overall radiation use. Rates of general utilization include those related to hospitalizations, total visits, and emergency department visits were also balanced between the two groups. Total spending in the year following diagnosis were statistically equivalent for NHS and SEER ($36,180 vs. $35,399, p = 0.70). CONCLUSIONS NHS and the general female population had comparable treatment and utilization patterns following diagnosis of early-stage incident breast cancers with the exception of type of radiation therapy received. This study provides support for the larger value of population-based cohorts in research on healthcare costs and utilization in breast cancer.
Collapse
Affiliation(s)
- Andrea M Austin
- The Dartmouth Institute for Health Policy and Clinical Practice at the Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
| | - Nirav S Kapadia
- The Dartmouth Institute for Health Policy and Clinical Practice at the Geisel School of Medicine at Dartmouth, Hanover, NH, USA.,Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.,Norris Cotton Cancer Center, Lebanon, NH, USA
| | - Gabriel A Brooks
- The Dartmouth Institute for Health Policy and Clinical Practice at the Geisel School of Medicine at Dartmouth, Hanover, NH, USA.,Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.,Norris Cotton Cancer Center, Lebanon, NH, USA
| | - Tracy L Onega
- The Dartmouth Institute for Health Policy and Clinical Practice at the Geisel School of Medicine at Dartmouth, Hanover, NH, USA.,Norris Cotton Cancer Center, Lebanon, NH, USA
| | - A Heather Eliassen
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Rulla M Tamimi
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Michelle Holmes
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Qianfei Wang
- The Dartmouth Institute for Health Policy and Clinical Practice at the Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Francine Grodstein
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Anna N A Tosteson
- The Dartmouth Institute for Health Policy and Clinical Practice at the Geisel School of Medicine at Dartmouth, Hanover, NH, USA.,Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.,Norris Cotton Cancer Center, Lebanon, NH, USA
| |
Collapse
|
7
|
Stamatovic L, Vasovic S, Trifunovic J, Boskov N, Gajic Z, Parezanovic A, Icevic M, Cirkovic A, Milic N. Factors influencing time to seeking medical advice and onset of treatment in women who are diagnosed with breast cancer in Serbia. Psychooncology 2017; 27:576-582. [PMID: 28857314 DOI: 10.1002/pon.4551] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 08/21/2017] [Accepted: 08/24/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Streamlining the diagnosis is a key factor in improving the treatment outcomes for breast cancer. The aim of this study was to determine factors influencing time to seeking medical advice and treatment onset in women who are diagnosed with breast cancer in Serbia. METHODS The study was a multicenter, cross-sectional national survey, performed at 10 oncology centers in Serbia. Time intervals spent throughout the complex diagnostic pathway were evaluated using a validated questionnaire administered to women with breast cancer (n = 800). Total interval (TI) was determined using predefined time scales, including one referring to patient interval (PI), and several related to health care system interval (SI). RESULTS Mean PI, SI, and TI were 4.5, 9.2, and 12.9 weeks, respectively; 20% of patients had a PI>12 weeks. Based on the multivariate regression model, longer PI was associated with perceived lack of time and personal disregard or trivialization of detected symptoms and signs. Women who were supported by family members or friends and had at least a secondary level education tended to have a shorter PI. Longer PI was correlated with a longer SI, while regular self-examination, having been diagnosed by an oncologist, and living in a major city were associated with shorter SI. CONCLUSIONS Several factors, related to psychological, demographic, behavioral, and health system characteristics, determined both the time to seeking medical advice and treatment onset for breast cancer. These findings support review and refining of national strategies and policies to promote early detection, diagnosis, and treatment of breast cancer.
Collapse
Affiliation(s)
- L Stamatovic
- Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - S Vasovic
- Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - J Trifunovic
- Oncology Institute of Vojvodina, Novi Sad, Serbia
| | - N Boskov
- General Hospital Zrenjanin, Zrenjanin, Serbia
| | - Z Gajic
- General Hospital Kruševac, Kruševac, Serbia
| | | | | | - A Cirkovic
- Institute for Medical Statistics and Informatics, University of Belgrade, Belgrade, Serbia
| | - N Milic
- Institute for Medical Statistics and Informatics, University of Belgrade, Belgrade, Serbia.,Department for Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
8
|
Demb J, Allen I, Braithwaite D. Utilization of screening mammography in older women according to comorbidity and age: protocol for a systematic review. Syst Rev 2016; 5:168. [PMID: 27716433 PMCID: PMC5050609 DOI: 10.1186/s13643-016-0345-y] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 09/20/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Approximately half of new invasive breast cancer cases diagnosed each year in the United States occur among women aged 65 years and older. The increasing life expectancy coupled with the attendant rise in breast cancer incidence and elimination of out-of-pocket expenses for screening mammography as a result of the Affordable Care Act could lead to higher utilization rates of screening mammography. Although research indicates that life expectancy should be a strong consideration when making screening decisions among older women, the extent to which screening mammography utilization is tailored to comorbidity and life expectancy is not well established. METHODS/DESIGN To identify relevant studies, a systematic search of the literature will be conducted using PubMed and EMBASE between January 1, 1991, and March 1, 2016. Additional studies will be found through citation review or by contacting experts in the field. The inclusion criteria will be any study design comprised of women aged 65 and older, assessing women's comorbidity, functional impairments, and/or health status, and reporting outcome measures that addressed mammography utilization within the last 1-5 years. For each study, two authors will independently abstract data regarding study eligibility and outcomes to determine relevance. Quantitative results will be extracted from text and tables, choosing preferably those adjusted for important confounders. DISCUSSION The review will provide evidence on the impact of comorbidity, functional limitations, and health status on screening mammography utilization in older women and inform decision aids in this area. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016032661.
Collapse
Affiliation(s)
- Joshua Demb
- Department of Epidemiology and Biostatistics, University of California, 550 16th Street, 2nd Floor, Box 0560, San Francisco, CA, 94143, USA
| | - Isabel Allen
- Department of Epidemiology and Biostatistics, University of California, 550 16th Street, 2nd Floor, Box 0560, San Francisco, CA, 94143, USA
| | - Dejana Braithwaite
- Department of Epidemiology and Biostatistics, University of California, 550 16th Street, 2nd Floor, Box 0560, San Francisco, CA, 94143, USA. .,Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA.
| |
Collapse
|
9
|
Hubbard RA, O'Meara ES, Henderson LM, Hill D, Braithwaite D, Haas JS, Lee CI, Sprague BL, Alford-Teaster J, Tosteson ANA, Wernli KJ, Onega T. Multilevel factors associated with long-term adherence to screening mammography in older women in the U.S. Prev Med 2016; 89:169-177. [PMID: 27261409 PMCID: PMC4969188 DOI: 10.1016/j.ypmed.2016.05.034] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 04/27/2016] [Accepted: 05/30/2016] [Indexed: 10/21/2022]
Abstract
In the U.S., guidelines recommend that women continue mammography screening until at least age 74, but recent evidence suggests declining screening rates in older women. We estimated adherence to screening mammography and multilevel factors associated with adherence in a longitudinal cohort of older women. Women aged 66-75years receiving screening mammography within the Breast Cancer Surveillance Consortium were linked to Medicare claims (2005-2010). Claims data identified baseline adherence, defined as receiving subsequent mammography within approximately 2years, and length of time adherent to guidelines. Characteristics associated with adherence were investigated using logistic and Cox proportional hazards regression models. Analyses were stratified by age to investigate variation in relationships between patient factors and adherence. Among 49,775 women, 89% were adherent at baseline. Among women 66-70years, those with less than a high school education were more likely to be non-adherent at baseline (odds ratio [OR] 1.96; 95% confidence interval [CI] 1.65-2.33) and remain adherent for less time (hazard ratio [HR] 1.41; 95% CI 1.11-1.80) compared to women with a college degree. Women with ≥1 versus no Charlson co-morbidities were more likely to be non-adherent at baseline (OR 1.46; 95% CI 1.31-1.62) and remain adherent for less time (HR 1.44; 95% CI 1.24-1.66). Women aged 71-75 had lower adherence overall, but factors associated with non-adherence were similar. In summary, adherence to guidelines is high among Medicare-enrolled women in the U.S. receiving screening mammography. Efforts are needed to ensure that vulnerable populations attain these same high levels of adherence.
Collapse
Affiliation(s)
- Rebecca A Hubbard
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA, United States.
| | | | - Louise M Henderson
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Deirdre Hill
- Department of Internal Medicine and Cancer Research and Treatment Center, University of New Mexico, Albuquerque, NM, United States
| | - Dejana Braithwaite
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, United States
| | - Jennifer S Haas
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Christoph I Lee
- Department of Radiology, University of Washington, Seattle, WA, United States; Department of Health Services, University of Washington, Seattle, WA, United States
| | - Brian L Sprague
- Department of Surgery, University of Vermont, Burlington, VT, United States
| | - Jennifer Alford-Teaster
- Department of Biomedical Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States; Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States; Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Anna N A Tosteson
- Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States; Department of Medicine, The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Medical School, Lebanon, NH, United States
| | - Karen J Wernli
- Group Health Research Institute, Seattle, WA, United States; Department of Health Services, University of Washington, Seattle, WA, United States
| | - Tracy Onega
- Department of Biomedical Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States; Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States; Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| |
Collapse
|
10
|
Braithwaite D, Walter LC, Izano M, Kerlikowske K. Benefits and Harms of Screening Mammography by Comorbidity and Age: A Qualitative Synthesis of Observational Studies and Decision Analyses. J Gen Intern Med 2016; 31:561-72. [PMID: 26831305 PMCID: PMC4835373 DOI: 10.1007/s11606-015-3580-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 06/23/2015] [Accepted: 12/08/2015] [Indexed: 01/22/2023]
Abstract
OBJECTIVE We conducted a systematic review to assess the quality and limitations of published studies examining benefits and harms of screening mammography in relation to comorbidity and age. METHODS We searched MEDLINE and EMBASE from January 1980 through June 2013 for studies that examined benefits or harms of screening mammography in women aged 65 years or older in relation to comorbidity. For each study, we extracted data regarding setting, design, quality, screening schedule, measure of comorbidity, and estimates of benefits and/or harms. We reviewed 1760 titles, identifying 7 articles that met the inclusion criteria: prospective cohort (two studies), retrospective cohort (two studies), and decision analyses (three studies). No randomized controlled trials were identified. RESULTS At least one measure of life expectancy or reduction in the risk of breast cancer death as a marker of benefit was examined in four studies, whereas three studies addressed the harms of screening mammography, including false-positive results. Both cohort studies and decision analyses showed that screening benefits decreased with increasing age and comorbidity burden. CONCLUSIONS The limited evidence currently available suggests that, apart from older women with severe comorbidity, women 65 and older may experience improvements in life expectancy from screening. Given the potential for harm, it is unclear whether the magnitude of the benefit is sufficient to warrant regular screening. Women, clinicians and policymakers should consider these factors in deciding whether continue screening.
Collapse
Affiliation(s)
- Dejana Braithwaite
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
| | - Louise C Walter
- Division of Geriatrics, San Francisco VA Medical Center and the University of California, San Francisco, CA, USA
| | - Monika Izano
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.,School of Public Health, University of California, Berkeley, CA, USA
| | - Karla Kerlikowske
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.,Division of General Internal Medicine, VA Medical Center, University of California, San Francisco, CA, USA
| |
Collapse
|
11
|
Braithwaite D, Demb J, Henderson LM. Optimal breast cancer screening strategies for older women: current perspectives. Clin Interv Aging 2016; 11:111-25. [PMID: 26893548 PMCID: PMC4745843 DOI: 10.2147/cia.s65304] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Breast cancer is a major cause of cancer-related deaths among older women, aged 65 years or older. Screening mammography has been shown to be effective in reducing breast cancer mortality in women aged 50–74 years but not among those aged 75 years or older. Given the large heterogeneity in comorbidity status and life expectancy among older women, controversy remains over screening mammography in this population. Diminished life expectancy with aging may decrease the potential screening benefit and increase the risk of harms. In this review, we summarize the evidence on screening mammography utilization, performance, and outcomes and highlight evidence gaps. Optimizing the screening strategy will involve separating older women who will benefit from screening from those who will not benefit by using information on comorbidity status and life expectancy. This review has identified areas related to screening mammography in older women that warrant additional research, including the need to evaluate emerging screening technologies, such as tomosynthesis among older women and precision cancer screening. In the absence of randomized controlled trials, the benefits and harms of continued screening mammography in older women need to be estimated using both population-based cohort data and simulation models.
Collapse
Affiliation(s)
- Dejana Braithwaite
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Joshua Demb
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Louise M Henderson
- Department of Radiology, University of North Carolina, Chapel Hill, NC, USA
| |
Collapse
|
12
|
Sanderson M, Levine RS, Fadden MK, Kilbourne B, Pisu M, Cain V, Husaini BA, Langston M, Gittner L, Zoorob R, Rust GS, Hennekens CH. Mammography Screening Among the Elderly: A Research Challenge. Am J Med 2015; 128:1362.e7-14. [PMID: 26169884 PMCID: PMC4658221 DOI: 10.1016/j.amjmed.2015.06.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 06/10/2015] [Accepted: 06/10/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Randomized trials demonstrate clear benefits of mammography screening in women through age 74 years. We explored age- and race-specific rates of mammography screening and breast cancer mortality among women aged 69 to 84 years. METHODS We analyzed Medicare claims data for women residing within Surveillance, Epidemiology and End Results geographic areas from 1995 to 2009 from 64,384 non-Hispanic women (4886 black and 59,498 white) and ascertained all primary breast cancer cases diagnosed between ages 69 and 84 years. The exposure was annual or biennial screening mammography during the 4 years immediately preceding diagnosis. The outcome was breast cancer mortality during the 10 years immediately after diagnosis. RESULTS After adjustment for stage at diagnosis, radiation therapy, chemotherapy, comorbid conditions, and contextual socioeconomic status, hazard ratios (and 95% confidence intervals) for breast cancer mortality relative to no/irregular mammography at 10 years for women aged 69 to 84 years at diagnosis were 0.31 (0.29-0.33) for annual mammography and 0.47 (0.44-0.51) for biennial mammography among whites and 0.36 (0.29-0.44) for annual mammography and 0.47 (0.37-0.58) for biennial mammography among blacks. Trends were similar at 5 years overall and stratified by ages 69 to 74 years, 75 to 78 years, and 79 to 84 years. CONCLUSIONS In these Medicare claims and Surveillance, Epidemiology and End Results data, elderly non-Hispanic women who self-selected for annual mammography had lower 10-year breast cancer mortality than corresponding women who self-selected for biennial or no/irregular mammography. These findings were similar among black and white women. The data highlight the evidentiary limitations of data used for current screening mammography recommendations.
Collapse
Affiliation(s)
- Maureen Sanderson
- Department of Family and Community Medicine, Meharry Medical College, Nashville, Tenn.
| | - Robert S Levine
- Department of Family and Community Medicine, Meharry Medical College, Nashville, Tenn
| | - Mary K Fadden
- Department of Family and Community Medicine, Meharry Medical College, Nashville, Tenn
| | - Barbara Kilbourne
- Department of Family and Community Medicine, Meharry Medical College, Nashville, Tenn
| | - Maria Pisu
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham
| | - Van Cain
- Center for Health Research, Tennessee State University, Nashville
| | - Baqar A Husaini
- Center for Health Research, Tennessee State University, Nashville
| | - Michael Langston
- Department of Electrical Engineering and Computer Science, University of Tennessee, Knoxville
| | - Lisa Gittner
- Department of Political Science, Texas Tech University, Lubbock
| | - Roger Zoorob
- Department of Family and Community Medicine, Meharry Medical College, Nashville, Tenn
| | - George S Rust
- Morehouse School of Medicine, National Center for Primary Care, Atlanta, Ga
| | - Charles H Hennekens
- Department of Family and Community Medicine, Meharry Medical College, Nashville, Tenn; Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton
| |
Collapse
|
13
|
Henderson LM, O'Meara ES, Braithwaite D, Onega T. Performance of digital screening mammography among older women in the United States. Cancer 2014; 121:1379-86. [PMID: 25537958 DOI: 10.1002/cncr.29214] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 11/14/2014] [Accepted: 11/17/2014] [Indexed: 01/05/2023]
Abstract
BACKGROUND Although healthy women aged 65 years have a life expectancy of 20 years, there is a paucity of data on the performance of digital screening mammography among these women. The authors examined the performance and outcomes of digital screening mammography among a national group of women aged ≥65 years. METHODS From Breast Cancer Surveillance Consortium data for the years 2005 to 2011, the authors included 296,496 full-field digital screening mammograms among 133,042 women ages ≥65 years without a history of breast cancer. Sensitivity, specificity, positive predictive value (PPV1 ), recall rates, and 95% confidence intervals (95% CIs) were calculated across the spectrum of age and breast density. Multivariate logistic regression was used to compare mammography accuracy, cancer-detection rates (CDRs), and tumor characteristics by age and breast density. RESULTS Multivariate analyses revealed a significant decrease in the recall rate with age (P for linear trend [Ptrend ] < .001) and significant increases in specificity, PPV1 , and CDR with age (Ptrend < .001, Ptrend < .001, and Ptrend = .01, respectively). Sensitivity did not vary significantly with age. Among women with cancer, the proportion with invasive disease increased with age from 76% at ages 65 to 74 years to 81% at ages ≥80 years. There was a higher proportion of late stage cancers and positive lymph nodes among women ages 65 to 74 years compared with women in the older age groups. CONCLUSIONS The specificity, PPV1 , recall rate, and CDR of digital screening mammography improved with increased age. In addition, as age increased, the proportion of women with invasive versus ductal carcinoma in situ rose, whereas the proportion of women with positive lymph nodes decreased.
Collapse
Affiliation(s)
- Louise M Henderson
- Department of Radiology, University of North Carolina, Chapel Hill, North Carolina
| | | | | | | | | |
Collapse
|
14
|
Malmgren JA, Parikh J, Atwood MK, Kaplan HG. Improved prognosis of women aged 75 and older with mammography-detected breast cancer. Radiology 2014; 273:686-94. [PMID: 25093690 DOI: 10.1148/radiol.14140209] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate the characteristics and outcomes of women aged 75 years and older with mammography-detected breast cancer, an age group not represented in mammography screening effectiveness studies. MATERIALS AND METHODS We conducted a HIPAA-compliant, prospective cohort study with waiver of informed consent in patients with primary breast cancer, aged 75 years and older, with stage 0-IV disease from 1990 to 2011, identified and tracked with our registry database (n = 1162). Details including stage, treatment, outcomes, and method of detection (by patient, physician, or mammography) were noted from the chart at the time of diagnosis. Kaplan-Meier estimation was used to compare invasive disease-specific survival rates. RESULTS Among patients with breast cancer aged 75 years and older, mammography detection of cancers increased over time, from 49% to 70% (P < .001). Mammography-detected cases were more often stage I (62%), whereas patient- and physician-detected cases were more likely stage II and III (59%). Over time, from 1990 to 2011, the incidence of stage II cancers decreased by 8%, the incidence of stage III cancers decreased by 8%, and the incidence of stage 0 cancers increased by 15% (P < .001). Patients with mammography-detected invasive breast cancer were more often treated with lumpectomy and radiation and underwent fewer mastectomies and less chemotherapy than patients with cancer detected by patients and physicians (P < .001). Mammography detection was associated with significantly better 5-year disease-specific survival for invasive breast cancer (97% vs 87% for patient- and physician-detected cancer [P < .001], respectively). CONCLUSION Mammography-detected breast cancer in women 75 years and older was diagnosed at an earlier stage, required less treatment, and had better disease-specific survival than patient- or physician-detected breast cancer. These findings indicate that the same benefits of mammography detection observed in younger women extend to older women.
Collapse
Affiliation(s)
- Judith A Malmgren
- From HealthStat Consulting, 12025 9th Ave NW, Seattle, WA 98177 (J.A.M.); School of Public Health,Department of Epidemiology, University of Washington, Seattle, Wash (J.A.M.); and Swedish Cancer Institute at Swedish Medical Center, Seattle, Wash (J.P., M.K.A., H.G.K.)
| | | | | | | |
Collapse
|