A Prospective Study of the Use and Effects of Screening Mammography in XXXX Aged 70 and Older.

@entity1 @entity0 @entity5 @entity3 @entity204
OBJECTIVES: To prospectively examine how age and comorbidity affect screening mammography use, @entity5 detection, and overall survival. DESIGN: Prospective, with median follow-up of 10.2  years. SETTING: A population-based cohort of Vermont @entity1 with data in the Vermont @entity0 Surveillance System. @entity1 : @entity1 aged 70 and older with no history of @entity0 (N  =  20,697). MEASUREMENTS: Rates of screening, diagnostic procedure use, and @entity0 diagnosis were examined according to age and comorbidity. The effect of @entity0 on overall survival was assessed in relation to detection mode, @entity5 characteristics, and treatment. RESULTS: Screening declined 9% per year after age 70 and 18% with each unit increase in comorbidity score, with corresponding increases in clinically detected @entity0 . @entity3 was associated with greater overall mortality (screen detected: hazard ratio (HR)  =  1.22, 95% confidence interval (CI)   =  1.07-1.40; clinically detected: HR  =  1.68, 95% CI  =  1.43-1.96). The latter HR reflects a much greater absolute risk of @entity204 for @entity1 in a population with high baseline mortality. Use of breast-conserving surgery as the only treatment for Stage I @entity5 increased markedly with age and was associated with shorter overall survival than radiation or mastectomy (relative risk  =  2.23, 95% CI  =  1.42-3.47). CONCLUSION: Lower screening mammography use by older @entity1 is associated with more clinically detected @entity0 , which are associated with poorer survival. Treatment received for early-stage @entity5 influences the effect of screening on survival.
