Right and Wrong Reasons To Be Screened

How would you feel if you found out that your 85-year-old mother (or grandmother, if you prefer) had just undergone a pelvic examination to obtain a routine Pap smear? Perhaps you'd be pleased, believing she was being provided the best possible preventive care for cervical cancer. Maybe you'd be reassured, seeing it as evidence that her doctor still cares about her. Perhaps you'd be angry, viewing it as another case of medical care run amok—testing that was far more likely to create problems than to solve them. Or you might find yourself feeling conflicted, recognizing that elements of all of the above might be true.

I suspect that your response to this thought experiment will predict your reaction to the article by Walter and colleagues in this issue: a telephone survey of the recent experiences of California women age 70 years or older. More than three quarters reported having a recent Pap smear (within 3 years) and the same proportion reported having recent mammography (within 2 years) (1). Even in the oldest group, screening was common; about 60% of women age 85 years or older reported being currently screened with each test.

As with all studies, researchers might quibble about some things. Some women (such as my wife and daughter) don't answer the phone. These women may have different health behaviors than those who do respond and might get screened at a different rate. But because the survey response rate of 64% is fairly high, screening would still be a common event for elderly women even if all nonrespondents were not getting screened. Other women may say they have been screened even though they have not. This behavior raises a thornier issue: What is being measured? Is it actual screening behavior or what women think is the “right answer”? …