Screening mammography among nursing home residents in the United States: Current guidelines and practice
Department of Quantitative Health Sciences; Department of Medicine, Division of Geriatrics; Department of Family Medicine and Community Health
Epidemiology | Geriatrics | Health Services Administration | Health Services Research | Neoplasms | Oncology
OBJECTIVE: United States (US) guidelines regarding when to stop routine breast cancer screening remain unclear. No national studies to-date have evaluated the use of screening mammography among US long-stay nursing home residents. This cross-sectional study was designed to identify prevalence, predictors, and geographic variation of screening mammography among that population in the context of current US guidelines.
MATERIALS AND METHODS: Screening mammography prevalence, identified with Physician/Supplier Part B claims and stratified by guideline age classification (65-74, > /=75years), was estimated for all women aged > /=65years residing in US Medicare- and Medicaid- certified nursing homes ( > /=1year) with an annual Minimum Data Set (MDS) 3.0 assessment, continuous Medicare Part B enrollment, and no clinical indication for screening mammography as of 2011 (n=389,821). The associations between resident- and regional- level factors, and screening mammography, were estimated by crude and adjusted prevalence ratios from robust Poisson regressions clustered by facility.
RESULTS: Women on average were 85.4 (standard deviation +/-8.1) years old, 77.9% were disabled, and 76.3% cognitively impaired. Screening mammography prevalence was 7.1% among those aged 65-74 years (95% Confidence Interval (CI): 6.8%-7.3%) and 1.7% among those > /=75years (95% CI, 1.7%-1.8%), with geographic variation observed. Predictors of screening in both age groups included race, cognitive impairment, frailty, hospice, and some comorbidities.
CONCLUSIONS: These results shed light on the current screening mammography practices in US nursing homes. Thoughtful consideration about individual screening recommendations and the implementation of more clear guidelines for this special population are warranted to prevent overscreening.
Health service utilization, Nursing homes, Screening mammography, UMCCTS funding
DOI of Published Version
J Geriatr Oncol. 2018 Jun 4. pii: S1879-4068(18)30025-0. doi: 10.1016/j.jgo.2018.05.005. [Epub ahead of print] Link to article on publisher's site
Journal of geriatric oncology
Mack D, Epstein MM, Dube CE, Clark RE, Lapane KL. (2018). Screening mammography among nursing home residents in the United States: Current guidelines and practice. Population and Quantitative Health Sciences Publications. https://doi.org/10.1016/j.jgo.2018.05.005. Retrieved from https://escholarship.umassmed.edu/qhs_pp/1215