Breast cancer screening in older women: the family practice perspective.

This article reviews screening for breast cancer in older women from the perspective of the primary care physician. Although breast cancer is a leading cause of cancer in women, the diagnosis of breast cancer in an asymptomatic woman is an uncommon occurrence for the individual physician. Physician compliance with breast cancer screening recommendations is less than optimum: physicians report higher compliance in survey studies than is demonstrated by performance audits. The low yield of screening, cost concerns, concerns about the reliability of radiology reports, concerns about patient compliance, lack of time, and forgetfulness are reasons cited for poor provider compliance with screening recommendations. In general there is no reason not to recommend mammography for older women unless individual factors including biologic age, life expectancy, comorbidities, or patient preference appear to make screening not worthwhile. The decision to stop recommending mammography for an older woman should be made in conjunction with the patient.