The extent of breast cancer screening in older women.

Women 65 and older present a unique challenge to health professionals, particularly with respect to breast cancer screening. These women are at the highest risk for developing breast cancer; they represent 50% of all newly diagnosed breast cancers. This group represents 60% of the breast cancer deaths, however, demonstrating how serious a disease breast cancer is in the 65-and-older age group. Moreover, the 65-and-older population cohort is growing rapidly. By 2010, it is estimated that greater than 15% of the population will be older than 65, and, as is the case now, the majority of this group will be women. Therefore, preventing breast cancer deaths in older women is a very significant and pressing issue. Ironically, most studies have reported that screening for breast cancer is less widespread in women older than 65 than in those younger than 65. Regional surveys emphasize a number of barriers, some of which seem to be age-specific--a lower level of knowledge about the usefulness and benefit of mammography, particularly in the absence of symptoms; less of a sense of personal vulnerability; fewer screening recommendations from family, friends, or physicians; and more problems with access (cost, transportation). To improve breast cancer screening rates in older women, sound health education interventions are needed to improve knowledge of and belief and attitudes regarding mammography. These should be targeted not only to older women, but also to their physicians and/or primary care givers. In addition, specific attention should be given to those barriers that are particularly burdensome for the elderly: cost, transportation problems, and loss of mobility.