Journal of General Internal Medicine

, Volume 34, Issue 12, pp 2720–2722 | Cite as

Who Orders Screening Mammograms in Older Women with Limited Life Expectancy?

  • Nancy L. SchoenbornEmail author
  • Jin Huang
  • Cynthia M. Boyd
  • Sarah Nowak
  • Craig E. Pollack
Concise Research Reports


Breast cancer screening in older women with limited life expectancy may pose more harms than benefits but many of these women still receive screening mammograms.1, 2 Clinician recommendation is an important driver of screening.2 Previous surveys suggest that specialists are more likely than generalists to recommend screening mammograms for older women.3, 4 With the goal of better targeting future interventions, we examined the specialties of the clinicians who referred older women for mammograms in a nationally representative cohort and whether the specialties varied depending on the women’s estimated life expectancies. We then investigated whether the receipt of screening mammograms was linked with outpatient visits with different types of clinicians.


Using data from the first wave of the National Health and Aging Trends Study (NHATS) in 2011 linked to Medicare claims, we identified women 65+ years old without history of breast cancer who were continuously...



Dr. Schoenborn was financially supported by a Cancer Control Career Development Award from the American Cancer Society (CCCDA-16-002-01) and a career development award from the National Institute on Aging (K76AG059984). Dr. Boyd was financially supported by 1K24AG056578 from the National Institute on Aging.

Author Contributions

Dr. Schoenborn had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Schoenborn, Huang, Boyd, Pollack.

Data analysis and interpretation: Schoenborn, Huang, Boyd, Nowak, Pollack.

Preparation and review of the manuscript: Schoenborn, Huang, Boyd, Nowak, Pollack

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they do not have a conflict of interest. Dr. Pollack has stock ownership in Gilead Pharmaceuticals. We do not believe this has resulted in any conflict with the design, methodology, or results presented in this manuscript. Dr. Cynthia Boyd received a small payment from UptoDate for having co-authored a chapter on Multimorbidity; we do not believe this has resulted in any conflict with the design, methodology, or results presented in this manuscript.


The funding sources had no role in the design, methods, subject recruitment, data collections, analysis, and preparation of paper.


  1. 1.
    Royce TJ, Hendrix LH, Stokes WA, et al. Cancer screening rates in individuals with different life expectancies. JAMA Intern Med. 2014;174(10):1558–65.CrossRefGoogle Scholar
  2. 2.
    Schonberg MA, Breslau ES, McCarthy EP. Targeting of mammography screening according to life expectancy in women aged 75 and older. J Am Geriatr Soc. 2013;61(3):388–395.CrossRefGoogle Scholar
  3. 3.
    Radhakrishnan A, Nowak SA, Parker AM, Visvanathan K, Pollack CE. Physician breast cancer screening recommendations following guideline changes: results of a national survey. JAMA Intern Med. 2017;177(6):877–878.CrossRefGoogle Scholar
  4. 4.
    Leach CR, Klabunde CN, Alfano C, Smith JL, Rowland JH. Physician over-recommendatoin of mammography for terminally ill women. Cancer. 2012;118(1):27-37CrossRefGoogle Scholar
  5. 5.
    Fenton JJ, Zhu W, Balch S, et al. Distinguishing screening from diagnostic mammograms using medicare claims data. Med Care. 2014;52(7): e44–51.CrossRefGoogle Scholar
  6. 6.
    Cruz M, Covinsky K, Widera EW, et al. Predicting 10-year mortality for older adults. JAMA. 2013;309(9):874–876.CrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  1. 1.The Johns Hopkins University School of MedicineBaltimoreUSA
  2. 2.RAND CorporationSanta MonicaUSA
  3. 3.The Johns Hopkins University School of Public HealthBaltimoreUSA

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