Health care professionals' preferences for extending mammographic breast screening to the over 70s

Abstract

Background Breast screening improves survival in women aged 50–70. The relative benefits of screening in women over 70 are reduced but women up to age 80 may still benefit. In the UK the National Health Service provides screening by self referral to women >70. This research has investigated health care professionals' (HCPs') preferences for extending screening to older women and factors they consider when advising about screening. Materials and methods UK HCPs for breast or elderly care were recruited. A questionnaire relating to screening in the >70s was administered. A sample of respondents were also interviewed to give added insight. Results Questionnaires were distributed to 488 HCPs and 139 replies received, (29%). A total of 26 professionals were also interviewed. Most felt the current system of self referral was under-utilized due to poor user awareness. Predicted life expectancy, co-morbidity and patient preference were viewed as important factors influencing screening recommendation. Chronological age was thought less important. The present system was thought flawed, but there was little enthusiasm for extending screening due to perceived risks and reduced cost efficacy. Some form of selectivity for fitter women was advocated. Conclusions There was acceptance that fitter older women may benefit from screening whilst the less fit may be harmed suggesting that some form of selective invitation would be preferable to the present system but would be practically difficult and costly to administer. The present system of self referral was felt to be inadequate due to low levels of awareness and uptake