Greater primary care access could lead to mammo overuse

Increased access to primary care could lead to overuse of mammography by older women who have a limited life expectancy, new research published in Medical Care suggests.

One of the problems, according to the authors, led by Alai Tan--a senior biostatistician at the University of Texas Medical Branch at Galveston--is that screening guidelines from some organizations, such as the American Cancer Society, don't have upper age limits. While, in general, they found that the use of mammography decreases as a woman's life span shortens, that trend, the said, could be arrested with better access to care.

The authors assessed screening mammography use in 106,737 women age 66 years and older between 2008 and 2009. They found that among women with a life expectancy of less than seven years, 28.5 percent received screening mammography during that span.

Broken down further, the screening rates were 34.6 percent for women with an identifiable primary care physician and 20.5 percent for those without. Rates were higher for women who saw more than one generalist physician and made more visits to those physicians.

Additionally, geographical differences were a factor; women with a limited life expectancy who lived in an area with greater access to mammography resources, more primary care physicians and more radiologists were more likely to undergo screening.

Research published last year in JAMA Internal Medicine reported on high costs associated with breast cancer screening in women over the age of 75, even though there is no evidence that higher spending results in better outcomes for such women.

Interestingly, research presented at the recent annual meeting of the American Roentgen Ray Society found that women significantly overestimate the amount of radiation associated with mammography, which could dissuade them from undergoing screening.

To learn more:
- see the study|
- read about the JAMA Internal Medicine study

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