Discontinuation of Screening Mammography After Serious Health Events

T he benefits associated with breast cancer screening and screening in general depend critically on patients’ life expectancy and the risk of death from competing causes. However, it is unclear if health care providers and patients take life expectancy into account when deciding whether to screen. A number of studies have examined the impact of age and health status on receipt of mammography. All find that mammography rates decline with age but report mixed results regarding the impact of comorbidities. These studies do not control for previous screening behavior. The present study used a new approach to evaluating the relationship between life expectancy and receipt of mammography that does not treat each mammogram as an isolated event. We identified a cohort of women who received screening mammograms in 2 consecutive years. Then, we determined how the occurrence of serious health events (eg, myocardial infarctions, strokes) affects receipt of a third screen. We view these events as serious health events that should lead patients and clinicians to revise downward their estimates of remaining life expectancy. This method better reflects the decision problem facing patients and clinicians.