Breast and cervical cancer screening for older women: recommendations and challenges for the 21st century.

The incidence of both breast and cervical cancer increases with age, and older socioeconomically disadvantaged and minority women are most likely to develop or die of these diseases. Early detection has the potential to decrease the disproportionate burden of disease in these vulnerable groups at a reasonable cost to society. Yet despite impressive overall gains in use of mammography and Pap smears, older women, especially older minority women, remain underrepresented in screening programs. Physician recommendation is one of the most powerful predictors of screening across all age, socioeconomic, and ethnic groups. The overwhelming majority of older women, make one or more physician visits each year, each of which represents an opportunity to screen for breast and cervical cancer. Although older women will accept screening if it is offered by their providers, physicians are less likely to offer it to them than to their younger, white patients. Conflicting professional recommendations for screening older women, leaving older women out of clinical trials of screening efficacy, competing causes of mortality with increasing age, and possible negative attitudes held by physicians and patients all contribute to the underscreening of older women. Cancer control challenges for the next century include defining groups of women most likely to benefit from screening (based on age, disease risk, competing mortality, and quality of life), improving regular use of early detection, educating providers, and conducting research on age-mediated differences in breast or cervical cancer biology that could affect screening recommendations.