Increasing mammography screening among women over age 50 with a videotape intervention

BACKGROUND: A randomized trial was conducted to test the effectiveness of a videotape for increasing mammography screening among a multiethnic sample of older women. METHODS: A multiethnic sample of Caucasian, African-American, and Hispanic women between the ages of 50 and 70 was recruited from Resident Lists compiled by the State of Massachusetts. After completing a baseline questionnaire, women were randomized to receive either a videotape or pamphlet about mammography and recontacted at 2 and 12 months after baseline to assess attitudes, beliefs, and mammography screening. A total of 581 women completed questionnaires at all three time points. RESULTS: At baseline, approximately 75% of women reported having a mammogram in the past year and 90% reported having one in the past 2 years. Rates did not differ between groups. At the 12-month follow-up, mammography rates, adjusted for baseline screening, were 80.4% in the video and 74.8% in the pamphlet group. Logistic regression analysis of mammography at 12 months (within past year vs. >1 year ago) controlling for baseline mammogram produced an odds ratio of 1.48 for the video group that was not significantly different from unity (95% CI = 0.95-2.28). CONCLUSIONS: The videotape had a small effect on increasing mammography screening. Although the effect was smaller than more intensive interventions, the video is a convenient, low cost, and easily implemented method to increase mammography screening.     

Screening mammography for women 50 years of age and older: practices and trends, 1987

Recently, public and private efforts have been mounted to promote screening mammography. To assess recent trends in the percentage of women 50 years of age and older who have had a screening mammogram, we analyzed data from interviews from women from 33 states who participated in the 1987 Behavioral Risk Factor Surveillance System. Our study group included 8,402 women 50 years of age and older who had visited a physician for a routine checkup in the last year; among these 8,402 women, only 29% reported having had a screening mammogram in the past year. However, of the women in the study group, the percentage who had a screening mammogram in the last year showed a relative increase of 38% during 1987, from 24% for women interviewed in the first quarter of 1987 to 33% for women interviewed in the fourth quarter. However, not all groups of patients benefited equally from the observed trend--the absolute and relative increases in the percentage of women screened were lowest for women who were older, less educated, in low-income groups, and who had poor personal health practices. Although the percentage of women 50 years of age and older who reported being screened increased dramatically during 1987, special efforts are needed to reach the patient groups that are being left behind in the trend toward increased use of screening mammograms.     

Low-to-moderate alcohol consumption and breast cancer risk by age 50 years among women in Germany

Studies of the association between alcohol drinking and breast cancer show a tendency towards an increase in risk for high consumption levels but yield less consistent results for low-to-moderate levels, particularly among premenopausal women. In a population-based case-control study in Germany, the authors determined the effect of alcohol consumption at low-to-moderate levels on breast cancer risk among women up to age 50 years. The study included 706 case women whose breast cancer had been newly diagnosed in 1992-1995 and 1,381 residence- and age-matched controls. In multivariate conditional logistic regression analysis, the adjusted odds ratios for breast cancer were 0.71 (95% confidence interval (CI): 0.54, 0.91) for average ethanol intake of 1-5 g/day, 0.67 (95% CI: 0.50, 0.91) for intake of 6-11 g/day, 0.73 (95% CI: 0.51, 1.05) for 12-18 g/day, 1.10 (95% CI: 0.73, 1.65) for 19-30 g/day, and 1.94 (95% CI: 1.18, 3.20) for > or = 31 g/day. The association with high daily ethanol intake of > or = 19 g was modified by educational level, such that odds ratios were 3.7, 1.6, and 0.7 for women with low, moderate, and high levels of education, respectively. These data suggest that low-level consumption of alcohol does not increase breast cancer risk in premenopausal women.     

Active and passive smoking and risk of breast cancer by age 50 years among German women

Recent studies suggest that both active and passive smokers have an increased risk of breast cancer compared with women who have never been either actively or passively exposed. Data on lifetime active and passive smoking were collected in 1999-2000 from 468 predominantly premenopausal breast cancer patients diagnosed by age 50 years and 1,093 controls who had previously participated in a German case-control study conducted in 1992-1995. Compared with never active/passive smokers, former smokers and current smokers had odds ratios of 1.2 (95% confidence interval (CI): 0.8, 1.7) and 1.5 (95% CI: 1.0, 2.2), respectively, and ever active smokers had an odds ratio of 1.3 (95% CI: 0.9, 1.9). The risk increased with duration of smoking and decreased after cessation of smoking. Among never active smokers, ever passive smoking was associated with an odds ratio of 1.6 (95% CI: 1.1, 2.4). Exposure to environmental tobacco smoke during childhood or before the first pregnancy did not appear to increase breast cancer risk. At greatest risk were women who had a high level of exposure to both passive and active smoking (odds ratio = 1.8, 95% CI: 1.2, 2.7). This study strengthens the hypothesis of a causal relation between active and passive smoke exposures and breast cancer risk.     

Characteristics of women 50 years of age or older with heterosexually acquired AIDS.

OBJECTIVES: This study compared characteristics of older (> or = 50 years) and younger (< 50 years) women with acquired immunodeficiency syndrome (AIDS) attributed to heterosexual contact. METHODS: We interviewed women with heterosexually acquired AIDS reported to 12 state and local health departments. Of 556 women interviewed, 59 (11%) were 50 or older. RESULTS: Older women were more likely than younger women to live alone (24% vs 11%), to have not completed high school (63% vs 37%), to be tested for human immunodeficiency virus (HIV) while hospitalized (51% vs 32%), and to have never used a condom before HIV diagnosis (86% vs 67%). CONCLUSIONS: Health care providers need to recognize HIV risk behavior in older women, encourage testing, and promote condom use.     

Food intake of institutionalized women over 80 years of age

Food intake of 30 women over 80 years of age and residing in a long-term care facility was determined for a five-day period using the weighed intake method. Purposes of the study were to examine the contribution to nutrient intake of foods from eight major food groups; to characterize intake by time of day; and to examine the effect of age on nutrient intake. The results indicated that intakes of calcium, thiamin, vitamin A, zinc, and protein were below recommended levels. Analysis of intake by food group revealed that the grain group was the primary source of energy and many nutrients. Percentage consumption of foods in this group was significantly higher than that of vegetables or meat and alternates. Analysis of intake by time of day indicated that more energy was consumed at breakfast than at dinner. Advanced age was negatively correlated with overall dietary adequacy, although the distribution of energy intake from the eight food groups did not change with age. Implications of the results, for these subjects and similar groups of elderly, are discussed.     

Is routine mammography screening appropriate for women 40-49 years of age?

This article reviews the evidence about screening for breast cancer. Results are now available from four randomized trials--one quasi-experimental study and three case control studies. Only the oldest, the Health Insurance Plan (HIP) Trial, shows any evidence of mortality reduction in women from 40 to 49 years of age. However, the evidence from the HIP trial is weak and somewhat contradictory. Preliminary data from a further trial in Sweden and the National Breast Screening Study in Canada confirm my conclusion that the scientific evidence is insufficient at present to recommend mammography screening for women 40-49 years of age. This conclusion reinforces the decision of the U.S. Preventive Services Task Force, but contradicts the guidelines of the American Cancer Society and the National Cancer Institute.     

Natural history of obesity in 6,946 women between 50 and 59 years of age.

A health survey of 6946 50-to-59 year-old women of TOPS, an organization for weight reduction, was used to study the natural history of obesity. Weight history was compared for four groups of women divided on the basis of their per cent above ideal body weight (IBW) in their 50s (less than 20%, 20-49%, 50-99% and 100+%). In each of the four groups, the majority of women were not obese by age 20. Sixteen per cent of the women who were 100+% overweight in their 50s were not obese at anytime during their first 30 years of life. Thirty-six per cent of the women who were 50-99% about IBW were not overweight at anytime prior to their 30th birthday. The history of obesity prior to age 30 was not associated with weight gain between the ages of 30 and 50. These data suggest: 1) than there is no critical time for the development of obesity, and 2) that previous weight history is not a dominant factor in determining subsequent weight gain.     

Biennial screening mammography is cost effective in healthy women aged over 65 years

QuestionWhat is the cost-effectiveness of screening mammography in women over 65 years old?Study designSystematic review with narrative synthesis.Main resultsTen studies, out of 115 identified, met inclusion criteria. Studies had similar cost-effectiveness findings; extending biennial screening to ages 75–80 years cost, on average, $34,000–$88,000 per life year gained compared with stopping screening at age 65 (adjusted to 2002 US dollars). Two studies found breast cancer screening less effective at reducing mortality in women with significant comorbidities (dementia, congestive heart failure, or hypertension), thus reducing the cost-effectiveness of screening in this population. No study fully adjusted for potential harms of screening.Authors’ conclusionsIn women aged over 65 years without serious comorbidity, biennial breast cancer screening reduces mortality at reasonable costs.     

Evolution of physical fitness and functional capacity in active elderly women over 50 years of age according to chronological age in Santos city

The scope of this study was to compare the evolution of physical fitness, functional capacity and bone mineral density in active elderly women over a one-year period. The sample consisted of 78 women from 50 to 79 years of age (c:62.4 ± 7.1) participating in an aerobic program, twice a week, 50 minutes per session during 3.4 years and divided into three age groups: A: 50-59 (n:38); B: 60-69 (n:28); C: 70-79 (n:12). Results were compared using Two Way ANOVA, "post-hoc" Bonferroni and delta (D%) variations (*p<.o1). The velocity of rising from a chair and gait speed revealed a significant difference in the three groups ranging from -14.3% to -45.5%; there was a significant improvement in A and B groups in walking speed (-12.1% to -13.9%), and also in maximum gait speed (-15.4% to -18.5%), elbow flexion in all the groups (18.9% to 24.1%), vertical jump (22.5% to 43.9%) in groups B and C, and rising from a chair in 30 seconds (25.2% to 30.8%) in groups A and B, the flexibility test showed an increase in group A (16.2% to 33.3%) and stationary walking in the three groups of (16,4% 30.0%) and bone mineral density (BMD) presented a significant increase (3.1% to 10.2%). The results indicate the salutary effect of regular physical activity.     

Screening mammography among Chinese Canadian women

BACKGROUND: Though breast cancer is the most common malignancy among Chinese women, screening mammography is underutilized. This study examined barriers and facilitators of screening mammography among Chinese Canadian women. METHODS: Using community-based sampling, Chinese women in British Columbia were interviewed in 1999 about multiple preventive health behaviours. We included 213 women in the mammography analysis; main outcome measures were ever having a mammogram and routine mammography. RESULTS: Seventy-five percent of women 50 to 79 years old reported ever having had a mammogram, and 53% had two or more mammograms within the last five years. Receiving a recommendation for a mammogram from medical personnel or from a family member, and believing that cancer cannot be prevented by faith were independently associated with both screening outcomes. CONCLUSIONS: A multifaceted approach to screening mammography promotion in Chinese Canadian women is suggested. Interventions that include education of and by medical providers and family members should be considered.     

Cigarette smoking, alcohol consumption, and screening mammography among women ages 50 and older

BACKGROUND: The associations among cigarette smoking and alcohol consumption with recent screening mammograms were evaluated among women ages 50 years and older. METHODS: The sample included 946 white and African-American women ages 50 years and older from the 1995 Maryland Behavioral Risk Factor Survey. Bivariate and logistic regression analyses were performed to evaluate the associations between current cigarette smoking and alcohol consumption in the past month (none, 1-7 drinks, >7 drinks) with obtaining a screening mammogram in the past 2 years (recent mammogram), controlling for sociodemographic and health variables. RESULTS: Seventy-eight percent of respondents had recent mammograms, 15% smoked cigarettes, 18% reported 1-7 drinks, and 12% reported >7 drinks in the past month. Smokers had lower mammography rates than nonsmokers (odds ratio (OR) = 0.47, 95% confidence interval (CI) = 0.30-0.75). Women who drank alcoholic beverages had higher mammography rates than nondrinkers (OR = 1.37, 95% CI = 1.03-1.83). Smokers had the lowest mammography rates, regardless of their consumption of alcohol. An interaction was observed among white but not African-American women: nonsmokers who consumed moderate amounts of alcohol (1-7 drinks) had the highest mammography rates in this subgroup. CONCLUSIONS: To reduce breast cancer mortality, it is important to increase screening mammography among all women over age 50 and especially among smokers and the oldest women.     

Prevalence of age related macular degeneration in persons aged 50 years and over resident in Australia.

STUDY OBJECTIVE--The aim was to determine, employing non-invasive procedures, the prevalence of age related macular degeneration in persons 50 years of age and over. DESIGN--A clinical investigation and a retrospective examination of ophthalmological records were employed in this study. SETTING--The study was conducted over the period 1988 to 1990 in the Western Metropolitan Health Region of New South Wales, Australia. PARTICIPANTS--A total sample of 3283 subjects stratified by local government area, age, and sex was obtained from the source population. It proved possible to confirm ophthalmological diagnoses in only 2522 of these subjects. MAIN RESULTS--All data were collected using accepted ophthalmological procedures and all diagnoses were confirmed through the use of independently derived ophthalmological records. A total of 428 subjects (13.0%) had a confirmed symmetrical diagnosis of age related macular degeneration. A total prevalence for diseased eyes of 14.9% was obtained. Prevalence of diseased eyes rose from 10.4% in those 50 to 64 years of age to 31.0% in those 85 years of age and over. CONCLUSIONS--There are several sources of error which can affect such a large sample study and are identified. Despite these, the prevalence rates obtained in this study provide normative rates for age related macular degeneration for persons 50 years of age and over.