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Data from a survey of primary care physicians practicing in Long Island, New York in 1990 show that physicians report that they are less likely to refer all of their elderly female patients--those 75 years of age and older--for routine screening mammograms than their patients age 50 to 75. According to physicians' self-reports, out-of-pocket costs to the patient for screening mammography are not considered a major deterrent to referrals in this age group. Physicians' decisions to refer elderly patients are affected by the patients' state of health and are associated with the specialty of the physician: obstetrician/gynecologists (OBGYNs) are more likely to make routine referrals of elderly patients for screening mammography than are family practitioners and general internists. The results of this analysis suggest that the new Medicare reimbursement for biennial screening mammograms will not result in immediate increases in utilization by elderly women, unless their physicians become more convinced of the utility of widespread mammographic screening for the elderly patient.