SUMMARIES FOR PATIENTS

Relationship of Health Status and Use of Mammography and Papanicolaou Smears among Women 70 Years of Age or Older

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The summary below is from the full report titled "Relationship between Health Status and Use of Screening Mammography and Papanicolaou Smears among Women Older Than 70 Years of Age." It is in the 4 May 2004 issue of Annals of Internal Medicine (volume 140, pages 681-688). The authors are L.C. Walter, K. Lindquist, and K.E. Covinsky.

What is the problem and what is known about it so far?

Breast cancer is an important health issue for older women. Mammography uses special x-rays of the breasts to try to find breast cancer at early, treatable stages. The benefits of mammography in women 50 to 70 years of age are clear. However, the benefits of mammography after age 70 years are less clear. After age 70 years, breast cancer is common, but so are other diseases. Some women are likely to die of another condition before dying of breast cancer.

Cancer of the cervix (the lower part of the uterus) is another concern for women. Papanicolaou (Pap) smears every 1 to 3 years can find cervical cancer at early, treatable stages. Pap smears involve an internal pelvic examination during which the doctor scrapes some cells from the cervix for examination under a microscope. It is unclear whether continuing regular Pap smears in women after age 65 years is of value, especially if a woman is more likely to die of other health conditions than of cancer of the cervix.

Mammography and Pap smears are unlikely to help patients who are likely to die of other conditions before dying of cancer. Doctors and patients should consider health status when making decisions about these screening tests.

Why did the researchers do this particular study?

To see whether elderly women in poor health are less likely to have mammography and Pap smears than are women in good health.

Who was studied?

4792 women who were at least 70 years of age and participated in a California telephone survey about health.

How was the study done?

The survey asked women questions about mammography and Pap smears. It also asked about their health status using a standard set of questions called the Medical Outcomes Study 12-item Short Form Physical Summary Scale (PCS-12). The PCS-12 asks patients to rate their own health and whether health decreases their ability to do certain activities. The researchers then determined whether recent mammography (within 2 years) or recent Pap smears (within 3 years) were associated with age and health status (measured with the PCS-12).

What did the researchers find?

More than three quarters of the women in the study reported having had recent mammography, Pap smear, or both. Older women were less likely than younger women to report having had the tests. However, within each age group (70 to 74 years, 75 to 79 years, 80 to 84 years, and at least 85 years), women who reported worse health were no less likely than those with better health to have had the tests. Over half of women 80 years of age and older who reported the worst health also reported recent screening.

What were the limitations of the study?

The researchers relied on women's reports of their last screening tests, which may not be completely accurate. In addition, they used the PCS-12, which relates to life expectancy in large groups of people but is not an accurate way to estimate an individual person's life expectancy.

What are the implications of the study?

There may be opportunities to better target screening mammography and Pap smears to women who are most likely to benefit from these tests.