Health Insurance and Public Policy: Risk, Allocation, and Equity

By Miriam K. Mills; Robert H. Blank | Go to book overview

11
Preventive Health Care for Older
Women: The Case of Breast
Cancer Screening

Michelle A Saint-Germain and Alice J. Longman


INTRODUCTION

Breast cancer is a leading killer of women over 50 years of age ( Leslie and Swider, 1986). All older women are considered to be at risk as 75 percent of breast cancers occur after age 50, and more than half of all breast cancer deaths occur after age 65 ( American Cancer Society, 1990; Gilbert and Low, 1986; Fernandez et al., 1986; Byrd, 1989). Despite two decades of research on treatment and prevention, the incidence of breast cancer is increasing (American Cancer Society, 1990; Shingleton and McCarty, 1987). One in nine women will eventually develop breast cancer ( Anstett, 1991). More than 150,000 new cases are detected and more than 44,000 women die from breast cancer in the United States each year ( American Cancer Society, 1990). Because many women from the "baby boom" generation are now turning 40, these numbers may substantially increase over the next 40 years ( U.S. Preventive Services Task Force, 1989).

While nothing can prevent the disease, breast cancer screening--when combined with early treatment--has been shown to be effective in reducing mortality rates, especially for women over 50 ( O'Malley and Fletcher, 1987). Discovery of breast cancer occurs nearly two years earlier for women age 35-49 and nearly three years earlier for women age 50 and over when they participate in screening tests than it would have without the tests ( Moskowitz , 1986). Startling differences in five-year survival rates are found for those who detect the cancer early (90 percent), after some spreading (68 percent), or late (18 percent) ( American Cancer Society, 1990). Screening and treatment are both important, as long-term survival depends on the

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