Of the 166 women aged 80 and older and 170 women aged 65–79 ultimately eligible for our study, 102 women aged 80 and older and 98 women aged 65–79 agreed to be interviewed, resulting in a combined response rate of 60%. Non-respondents (n = 136) were similar to respondents with regard to age, race/ethnicity, insurance, CCI, number of clinic visits in the past year, and receipt of mammography. Five women initially identified in the 65–79 age group had turned 80 years by the time they were interviewed and their responses were included with women aged 80 and older. Of the 339 women excluded from the study, 115 did not speak English, 82 had dementia, 77 had left the practice, 24 were deceased, 17 were hearing impaired, 15 were terminally ill, and 9 had physicians who thought the survey would be too psychologically disturbing.
Of the 200 women who participated in the survey, 53.5% were aged 80 and older (mean age 85.3 years) and 46.5% were aged 65–79 (mean age 71.5 years). The majority were non-Hispanic white (65.5%) and were in good to excellent health (82.8%). Most (81.3%) had undergone mammography screening in the previous 2 years (88.2% of women aged 65–79 and 75.2% of women aged 80 and older, p = 0.02). Women aged 80 and older were significantly more likely than women aged 65–79 to report a household income less than $20,000 per year (55.7% vs. 28.8%) and to have a functional dependency (47.7% vs. 14.0%) (Table ).
Characteristics of respondents by age group.
Table illustrates the proportion of women in each age group that considered various factors essential/very important to their mammography screening decision. Although there were no statistical differences by age, among women who were recently screened (n = 162) the majority considered a history of breast disease, a doctor's recommendation, receipt of a reminder card, reassurance, and habit as essential/very important factors in their decision (Table ). Fewer women considered family history of breast cancer, family member or friend's recommendation, friend's experience with breast cancer, health, age, or the media as essential/very important to their decision. Only small numbers of older women chose not to be screened and there were no statistical differences in factors influencing this decision by age (Table ). However, the majority of women aged 80 and older considered age as essential/very important to their decision not to be screened. In addition, 80.8% of women aged 65 and older who chose not to be screened were not concerned about breast cancer.
Proportion of women who considered each factor essential/very important in decision to get a mammogram.
Proportion of women who considered each factor essential/very important in decision NOT to get a mammogram.
Figure demonstrates how older women ranked the importance of different factors on their decision to undergo mammography screening. Both women aged 65–79 and women aged 80 and older ranked their doctor's recommendation as the most important factor influencing their decision. Habit and reassurance were the next two factors influencing older women's decision to get screened. There were no significant differences in scores given to factors that influence older women's mammography screening decisions by age. Women aged 80 and older who did not get screened with mammography in the past two years ranked age and then doctor's counseling as the most important factors influencing this decision. Women aged 65–79 ranked a previous negative experience with mammography as the most important factor influencing their decision not to get screened and then a lack of concern about breast cancer. Women aged 80 and older were significantly more likely than younger women to score age highly as a factor influencing their decision not to get screened (p = 0.02).
Figure 1 How older women ranked factors influencing their decision to undergo mammography screening in the past two years.* * To create these rankings we asked women to rate the 3 factors most influential to their decision to undergo mammography in the past 2 (more ...)
Table demonstrates receipt of mammography screening among older women by their preferred role in decision-making around screening and by their age. There were no statistically significant differences in women's preferred role in decision-making by age. However, most women in both age groups preferred to make the final decision on their own about whether or not to undergo mammography screening. Women aged 80 and older who preferred to share their mammography screening decision with their doctor were less likely to be screened (59.1%) than women aged 65–79 who preferred to share their decision with their doctor (96.2%). In addition, in post hoc analyses using the Fischer Exact test, we found that women aged 80 and older who preferred to share their decision and perceived themselves to be in good to excellent health were significantly more likely to be screened (76.5%, n = 13/17) than those who preferred to share their decision and perceived themselves to be in fair or poor health (0% n = 0/4) (p = 0.01). Receipt of screening did not differ by perceived health among women aged 80 and older who did not prefer to share their decision making around screening with their physician.
Receipt of mammography screening in the past 2 years by preferred role in decision-making around screening and by age.