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To the Editor: Dr Kerlikowske and colleagues¹ attempt to delineate a clinical strategy to identify groups of older women who could realize the greatest benefits from mammography screening at the most reasonable costs. The importance of achieving this goal is underscored by converging epidemiologic and demographic trends: breast cancer is a disease of old age, and by the year 2030, 1 in 5 women will be aged 65 years and older. The greatest increase in this older population will be among the group for which there is the least data and consensus on the value of screening: women aged 80 years and older.

As Kerlikowske et al acknowledge, older women are physiologically heterogenous. For instance, there are important age-related variations in comorbidity, mammographic sensitivity, natural history of disease, and morbidity associated with breast cancer and its treatments. All of these factors affect screening-related survival benefits. Women also differ in preferences . . . [Full Text of this Article]

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