Breast Cancer Screening for Elderly Women with and without Comorbid Conditions

doi:10.1059/0003-4819-116-9-722

Breast Cancer Screening for Elderly Women with and without Comorbid Conditions

A Decision Analysis Model

Abstract

▪ Objective: To determine whether breast cancer screening extends life for women aged 65 years or more with and without comorbid medical conditions.

▪ Setting: A provider-patient encounter.

▪ Design: A decision analysis of the utility of screening for breast cancer.

▪ Measurements: Clinical examination and mammography among four groups of women aged 65 to 85 or more years: average health, mild hypertension, congestive heart failure, and average-health black women. The effects of screening were estimated using the best quality data available.

▪ Results: Screening saved life at all ages among patients studied. Savings were highest for black women and decreased with increasing age and comorbidity. Screening all average-health women aged 65 or more saved 67 912 years of life. For women who had cancer, screening extended life by 617 days for average-health women between 65 and 69 years of age and 178 days for those aged 85 years or more. Perioperative mortality and test characteristics had little effect on the results. The risks equaled the benefits of screening only when operative mortality was between 27% and 62%. The marginal costs of screening during a routine office visit were $138 and increased with advancing age and decreasing test specificity. Benefits persisted after adjustment for changes in long-term quality of life; however, for women aged 85 years and older (with and without comorbidities), the short-term morbidity of anxiety or discomfort associated with screening may have outweighed the benefits.

▪ Conclusion: No inherent reason exists to impose an upper-age limit for breast cancer screening; however, more data are needed on women's preferences for screening strategies.

Article and Author Information

From Memorial Sloan-Kettering Cancer Center, Cabrini Medical Center, and Cornell University Medical College, New York, New York; Montefiore Medical Center, Albert Einstein School of Medicine, Bronx, New York; and Beth Israel Hospital and Harvard Medical School, Boston, Massachusetts. For current author addresses, see end of text.
Grant Support: In part by National Institute on Aging Award ♯ KO8 AG00471 (Dr. Mandelblatt); Dr. Monane is currently a Merck/American Federation for Aging Research Fellow in Geriatric Clinical Pharmacology.
Requests for Reprints: Jeanne Mandelblatt, MD, MPH, Memorial Sloan-Kettering Cancer Center, Division of Cancer Control, 1275 York Avenue, Box ♯60, New York, NY 10021.
Current Author Addresses: Dr. Mandelblatt and Mr. Tang: Memorial Sloan-Kettering Cancer Center, Division of Cancer Control, 1275 York Avenue, Box ♯60, New York, NY 10021.

Dr. Wheat: Department of Medicine, Montefiore Medical Center, Centennial Building, 4th floor, 111 East 210th Street, Bronx, NY 10467.

Dr. Monane: Program for the Analysis of Clinical Strategies, 333 Longwood Avenue, 3rd floor, Boston, MA 02115.

Ms. Moshief: Cabrini Medical Center, Information Systems, 227 East 19th Street, 9th flr, Building D, New York, NY 10003. Dr. Hollenberg: Department of Medicine, Cornell University Medical College, 525 East 68th Street, New York, NY 10021.