Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States.
Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States; Department of Medicine, Division of Geriatrics, University of Massachusetts Medical School, Worcester, MA, United States.
J Geriatr Oncol. 2018 Nov;9(6):626-634. doi: 10.1016/j.jgo.2018.05.005. Epub 2018 Jun 4.
United States (US) guidelines regarding when to stop routine breast cancer screening remain unclear. No national studies to-date have evaluated the use of screening mammography among US long-stay nursing home residents. This cross-sectional study was designed to identify prevalence, predictors, and geographic variation of screening mammography among that population in the context of current US guidelines.
Screening mammography prevalence, identified with Physician/Supplier Part B claims and stratified by guideline age classification (65-74, ≥75 years), was estimated for all women aged ≥65 years residing in US Medicare- and Medicaid- certified nursing homes (≥1 year) with an annual Minimum Data Set (MDS) 3.0 assessment, continuous Medicare Part B enrollment, and no clinical indication for screening mammography as of 2011 (n = 389,821). The associations between resident- and regional- level factors, and screening mammography, were estimated by crude and adjusted prevalence ratios from robust Poisson regressions clustered by facility.
Women on average were 85.4 (standard deviation ±8.1) years old, 77.9% were disabled, and 76.3% cognitively impaired. Screening mammography prevalence was 7.1% among those aged 65-74 years (95% Confidence Interval (CI): 6.8%-7.3%) and 1.7% among those ≥75 years (95% CI, 1.7%-1.8%), with geographic variation observed. Predictors of screening in both age groups included race, cognitive impairment, frailty, hospice, and some comorbidities.
These results shed light on the current screening mammography practices in US nursing homes. Thoughtful consideration about individual screening recommendations and the implementation of more clear guidelines for this special population are warranted to prevent overscreening.
美国（US）关于何时停止常规乳腺癌筛查的指南仍不明确。迄今为止，尚无全国性研究评估美国长期居住在养老院居民的筛查性乳房 X 光检查的使用情况。本横断面研究旨在根据当前美国指南，确定该人群中筛查性乳房 X 光检查的流行率、预测因素和地理差异。
使用医师/供应商 B 部分索赔确定筛查性乳房 X 光检查的流行率，并按指南年龄分类（65-74 岁，≥75 岁）进行分层，对所有年龄≥65 岁的女性进行估计，这些女性居住在美国医疗保险和医疗补助认证的养老院（≥1 年），并具有年度最低数据集（MDS）3.0 评估、连续医疗保险 B 部分注册，并且截至 2011 年没有筛查性乳房 X 光检查的临床指征（n=389,821）。使用稳健泊松回归对居民和地区水平因素与筛查性乳房 X 光检查的关联进行估计，回归结果采用机构聚类的粗比值比和调整比值比。
女性平均年龄为 85.4 岁（标准差±8.1 岁），77.9%为残疾，76.3%认知受损。65-74 岁年龄组的筛查性乳房 X 光检查流行率为 7.1%（95%置信区间（CI）：6.8%-7.3%），≥75 岁年龄组为 1.7%（95% CI，1.7%-1.8%），观察到地理差异。两个年龄组中筛查的预测因素包括种族、认知障碍、衰弱、临终关怀和一些合并症。
这些结果阐明了美国养老院目前的筛查性乳房 X 光检查实践。需要仔细考虑针对该特殊人群的个体筛查建议和更明确的指南，以防止过度筛查。
