Older Women and Breast Cancer Screening: Research Synthesis
Purpose/Objectives: To identify the most beneficial ways to support older women as they make screening decisions using a systematic, epidemiologic, narrative review of research regarding benefits and burdens of breast cancer screening and treatment.
Data Sources: Medical and nursing research databases emphasizing women aged 60 and older.
Data Synthesis: Older women can tolerate screening and treatment, yet they are underserved. The most frequently cited reason to explain this phenomenon is declining health status associated with aging. Research evidence does not support this claim. No evidence clearly describes relationships among health status, aging, and less screening or less aggressive treatment.
Conclusions: Older women experience varied health problems. However, indications that they are less able than their younger counterparts to tolerate screening or treatment for breast cancer do not exist.
Implications for Nursing: Further research in all aspects of breast cancer care in older women is required to define and describe risks and benefits of screening within a context of aging and changing health. Nurses should discuss the risks and benefits of screening with older women.
Jump to a section
References
Balducci, L. (2000). Geriatric oncology: Challenges for the new century. European Journal of Cancer, 36, 1741-1754.
Blustein, J., & Weiss, L.J. (1998). The use of mammography by women aged 75 and older: Factors related to health, functioning, and age. Journal of the American Geriatric Society, 46, 941-946.
Brogdon, C.F. (1998). Women and cancer. Journal of IV Nursing, 21, 344-355.
Burns, R.B., McCarthy, E.P., Freund, K.M., Marwill, S.L., Shwartz, M., Ash, A., et al. (1996). Variability in mammography use among older women. Journal of the American Geriatric Society, 44, 922-926.
Chang, B.L., Sarna, L., & Carter, P.A. (2001). Mammography screening behavior in older women caregivers. Geriatric Nursing, 22(1), 33-36.
Cimprich, B. (1999). Pretreatment symptom distress in women newly diagnosed with breast cancer. Cancer Nursing, 22, 185-194.
Devesa, S.S., & Hunter, C.P. (2000). The burden of cancer in the elderly. In C.P. Hunter, K.A. Johnson, & H. Muss (Eds.)Cancer in the elderly (pp. 1-24). New York: Marcel Dekker.
Ferrini, R., Mannino, E., Ramsdell, E., & Hill, L. (2000). Screening mammography for breast cancer: American College of Preventive Medicine practice policy statement. Retrieved September 18, 2000, from http://www.acpm.org/breast.htm
Fleming, S.T., Rastogi, A., Dmitrienko, A., & Johnson, K.D. (1999). A comprehensive prognostic index to predict survival based on multiple comorbidities. Medical Care, 37, 601-614.
Hill, A.B. (1965). The environment and disease: Association or causation? Proceedings of the Royal Society of Medicine, 58, 295-300.
Johnson, K.A. (2000). Cancer prevention in the elderly. In C.P. Hunter, K.A. Johnson, & H. Muss (Eds.)Cancer in the elderly (pp. 57-67). New York: Marcel Dekker.
Kerlikowske, K., Grady, D., Rubin, S.M., Sandrock, C., & Ernster, V.L. (1995). Efficacy of screening mammography: A meta-analysis. JAMA, 273, 149-154.
Kerlikowske, K., Salzmann, P., Phillips, K.A., Cauley, J.A., & Cummings, S.R. (1999). Continuing screening mammography in women aged 70-79 years: Impact on life expectancy and cost-effectiveness. JAMA, 282, 2156-2163.
Kiefe, C.I., Funkhouser, E., Fouad, M.N., & May, D.S. (1998). Chronic disease as a barrier to breast and cervical cancer screening. Journal of General Internal Medicine, 13, 357-365.
Kimmick, G. (2000). Breast cancer. In C.P. Hunter, K.A. Johnson, & H. Muss (Eds.)Cancer in the elderly (pp. 233-257). New York: Marcel Dekker.
Kimmick, G., & Muss, H.B. (1997). Breast cancer in older women. Clinics in Geriatric Care, 13, 265-282.
Marwill, S.L., Freund, K.M., & Barry, P.P. (1996). Patient factors associated with breast cancer screening among older women. Journal of the American Geriatric Society, 44, 1210-1214.
Michielutte, R., Dignan, M.B., & Smith, B.L. (1999). Psychosocial factors associated with the use of breast cancer screening by women age 60 years and over. Health Education and Behavior, 26, 625-647.
National Women's Law Center. (2000). Making the grade on women's health: A national and state-by-state report card. Retrieved March 5, 2001, from http://www.nwlc.org/archive.cmf
Olsen, O., & Gotzsche, P.C. (2001). Cochrane review on screening for breast cancer with mammography. Lancet, 358, 1340-1342.
Pusic, A., Thompson, T.A., Kerrigan, C.L., Sargeant, R., Slezak, S., Chang, B.W., et al. (1999). Surgical options for early-stage breast cancer: Factors associated with patient choice and postoperative quality of life. Plastic and Reconstructive Surgery, 104, 1325-1333.
Riley, G.F., Potosky, A.L., Klabunde, C.N., Warren, J.L., & Ballard-Barbash, R. (1999). Stage at diagnosis and treatment patterns among older women with breast cancer: An HMO and fee-for-service comparison. JAMA, 281, 720-726.
Rowe, J.W., & Kahn, R.L. (1998). Successful aging. New York: Pantheon Books.
Satariano, W.A., & Ragland, D.R. (1994). The effect of comorbidity on 3-year survival of women with primary breast cancer. Annals of Internal Medicine, 120, 104-110.
Smith, R.A., Saslow, D., Sawyer, K.A., Burke, W., Costanza, M.E., Evans, W.P., et al. (2003). American Cancer Society guidelines for breast cancer screening: Update 2003. CA: A Cancer Journal for Clinicians, 53, 141-169.
Solin, L.J., Schultz, D.J., Hanchak, N.A., & Kessler, H.B. (1999). Patterns of treatment for older women with newly diagnosed breast carcinoma. American Journal of Clinical Oncology, 22, 107-113.
Susann, P., Susann, P.W., Ackerman, S., Gibbons, R., Hermann, K., & Kuhn, P. (1999). Treatment outcomes for female octogenarians with breast cancer. American Surgeon, 65, 399-401.
U.S. Preventive Services Task Force. (2002). Recommendations and rationale: Screening for breast cancer. Retrieved February 25, 2002, from http://www.ahrq.gov/clinic/3rduspstf/breastcancer/brcanrr.htm
Weed, D.L. (2000). Epidemiologic evidence and causal inference. Hematology and Oncology Clinics of North America, 14, 797-807.
Yancik, R., Wesley, M.N., Ries, L.A.G., Havlik, R.J., Edwards, B.K., & Yates, J.W. (2001). Effect of age and comorbidity in postmenopausal breast cancer patients aged 55 years and older. JAMA, 285, 885-892.