Use of Surveillance Mammography Among Older Breast Cancer Survivors by Life Expectancy

Purpose The benefits of annual surveillance mammography in older breast cancer survivors with limited life expectancy are not known, and there are important risks; however, little is known about mammography use among these women. Materials and Methods We used National Health Interview Study data from 2000, 2005, 2008, 2010, 2013, and 2015 to examine surveillance mammography use among women age 65 years who reported a history of breast cancer. Using multivariable logistic regression, we assessed the probability of mammography within the last 12 months by 5- and 10-year life expectancy (using the validated Schonberg index), adjusting for survey year, region, age, marital status, insurance, educational attainment, and indicators of access to care. Results Of 1,040 respondents, 33.7% were age >= 80 years and 88.6% were white. Approximately 8.6% and 35.1% had an estimated life expectancy of <= 5 and <= 10 years, respectively. Overall, 78.9% reported having routine surveillance mammography in the last 12 months. Receipt of mammography decreased with decreasing life expectancy (P < .001), although 56.7% and 65.9% of those with estimated <= 5-year and <= 10-year life expectancy, respectively, reported mammography in the last year. Conversely, 14.1% of those with life expectancy > 10 years did not report mammography. In adjusted analyses, lower (v higher) life expectancy was significantly associated with lower odds of mammography (odds ratio, 0.4; 95% CI, 0.3 to 0.8 for <= 5-year life expectancy and OR, 0.4; 95% CI, 0.3 to 0.6 for <= 10-year life expectancy). Conclusion Many (57%) older breast cancer survivors with an estimated short life expectancy (< 5 years) receive annual surveillance mammography despite unknown benefits, whereas 14% with estimated life expectancy > 10 years did not report mammography. Practice guidelines are needed to optimize and tailor follow-up care for older patients.