Benefits and Burdens of Screening Oldest-old Women: the Case of Mammography

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DESCRIPTION (provided by applicant): As people age into their 80's and 90's they become more heterogeneous in terms of their health and recommendations for health promotion must be individualized. More data on the benefits and risks of many health promotion measures for women aged 80 and older are necessary to help clinicians target use of these measures to those women most likely to benefit. The projects proposed in this application focus on the benefits and burdens of mammography screening for women aged 80 and older. In the future, Dr. Schonberg plans to use the skills she obtains from this career development award to explore the benefits and risks of other screening tests and health promotion measures for elderly women. Dr. Schonberg proposes two related and complementary projects to gather data on the benefits and burdens of mammography screening for women aged 80 or older. For the first project she will use data from the linked Surveillance, Epidemiology and End Results (SEER) registry-Medicare database to describe breast cancer tumor characteristics, stage-specific treatments, and survival of women aged 80 and older newly diagnosed with breast cancer, and compare these with women aged 66 to 79 after considering health and proxies for socioeconomic status. The second project is a pilot longitudinal observational study to describe the psychological impact and the decision-making process after an abnormal mammogram of women aged 80 and older compared to women aged 65-79. Through coursework, seminars, and the development and completion of these rigorous studies, Dr. Schonberg plans to enhance her methodological skills and understanding of geriatric principles; learn to work with Medicare and other claims data and to perform longitudinal and survival analyses; develop expertise in psychometric testing and assessing elderly women's medical decision-making; and collect data that can be used to create tools to help women aged 80 or older and their clinicians make decisions around mammography screening. This career development award will allow Dr. Schonberg to acquire additional research skills and expertise and to collect data to aid decision- making around breast cancer screening, diagnosis, and treatment among women aged 80 and older. It will also further her long-term career goal to become a skilled and established independent investigator in the area of disease prevention and health promotion for the oldest-old.