Most older women don't get regular mammograms; mailed reminder can help

More than half of women over the age of 65 who should be getting regular mammograms aren't, a new study finds.

But a companion study shows that a simple mailing—reminding these women of their Medicare coverage for the exam, and of the high risk of breast cancer they face due to their age—is enough to prompt a meaningful increase in mammogram use.

The two studies by researchers from the U-M Health System (UMHS) and School of Public Health (SPH) show that older women may need an extra push from their doctors, families and Medicare administrators to go get a screening test that may save their lives.

The researchers say that extra push can be as simple as an inexpensive but personalized mailing made possible by Medicare's computer database systems.

"Older women seem to be using their age as a reason to stop getting mammograms, but we know that their risk of breast cancer—and the effectiveness of mammography in identifying it early—rises with age," says lead author R. Van Harrison, associate professor in the Medical School's Department of Medical Education.

The U-M team performed the two-part research using Michigan's computerized Medicare database and funding from the National Cancer Institute.

First, they looked back at all mammogram use from 1993-97 among 10,000 randomly sampled Michigan women over the age of 65. Those results are published in the March issue of Cancer.

Then they performed a controlled study to see if a carefully designed personalized mailing would boost mammogram rates among women who hadn't had the exam in the last five years. The data from that study are in the March issue of Medical Care.

The mammogram use study found that 43 percent of the women had not had a single exam in the five years of the study, and 17 percent had only one. The team then sent a personalized letter to more than 1,200 women over 70 years of age who hadn't had a mammogram in five years, urging them to schedule one. Though the absolute increase in this group's mammogram rate was modest, the recipients were 60 percent more likely to get an exam than 1,200 similar women who didn't get a letter.

A woman's risk of breast cancer rises throughout her life, and women in their 60s, 70s and 80s have the highest risk of all. Fifty-nine percent of breast cancer deaths occur in women ages 65 or older. Meanwhile, mammograms are most accurate in women of these ages, with lower chances of anxiety-raising false positives because older women's breasts are less dense.

In addition to Harrison, the authors of the studies include Dr. Laurence McMahon Jr., chief of general medicine in the Medical School's Department of Internal Medicine; Nancy Janz, SPH associate professor; Dr. Jeoffrey Stross, professor of general medicine; Michael Chernew, SPH and General Medicine associate professor; Robert Wolfe, professor, SPH; Philip Tedeschi, professor, SPH; and Xuelin Huang, formerly SPH, now at the M.D. Anderson Cancer Center.

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