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

描述（由申请人提供）：随着人们进入八九十岁，他们的健康状况变得更加多样化，促进健康的建议必须个性化。需要更多关于许多促进80岁及以上妇女健康措施的益处和风险的数据，以帮助临床医生将这些措施的使用目标锁定在最有可能受益的妇女身上。本申请中提出的项目侧重于80岁及以上妇女乳房x光检查的益处和负担。在未来，Schonberg博士计划利用她从这个职业发展奖项中获得的技能，探索其他筛查测试和健康促进措施对老年妇女的好处和风险。Schonberg博士提出了两个相关和互补的项目，以收集关于80岁及以上女性乳房x光检查的好处和负担的数据。在第一个项目中，她将使用相关的监测、流行病学和最终结果（SEER）登记-医疗保险数据库的数据来描述乳腺癌肿瘤特征、阶段特异性治疗和80岁及以上新诊断为乳腺癌的妇女的生存率，并将这些数据与66至79岁妇女的健康状况和社会经济地位进行比较。第二个项目是一项实验性纵向观察研究，旨在描述80岁及以上女性与65-79岁女性相比，乳房x光检查异常后的心理影响和决策过程。通过课程、研讨会以及这些严谨研究的发展和完成，Schonberg博士计划提高她的方法技能和对老年原则的理解；学习处理医疗保险和其他索赔数据，并进行纵向和生存分析；发展心理测量测试和评估老年妇女医疗决策方面的专门知识；并收集数据，用于创建工具，帮助80岁或以上的女性及其临床医生在乳房x光检查方面做出决定。该职业发展奖将使Schonberg博士获得额外的研究技能和专业知识，并收集数据，以帮助80岁及以上女性的乳腺癌筛查，诊断和治疗决策。这也将进一步推动她的长期职业目标，成为疾病预防和促进老年人健康领域的熟练和成熟的独立研究者。

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.