Outcomes Award Advances Research Aimed At Helping Clinicians Weigh Risks and Benefits of Screening Mammography for Women 80 and Older

As a resident, Mara Schonberg, MD, MPH, was generally encouraged to order screening mammograms for women patients -- no matter their age or health. Even as a trainee, however, she wondered whether the possible benefits of mammography screening for very old women -- those 80 and older -- outweighed the possible drawbacks.

"There are several potential drawbacks," explains Dr. Schonberg, an instructor at Harvard Medical School and Beth Israel Deaconess Medical Center. "There's anxiety related to false positives or to the diagnosis of a disease that might never become clinically significant in the woman's lifetime. Subjecting a woman who's 80 or older to treatment for a cancer that would never become clinically significant in her lifetime would also be a drawback."

Hoping to get a better sense of the burdens and benefits of screening mammography for very old women, Dr. Schonberg initially looked to available data, but found there wasn't much out there. Now, with the support of a 2006 Hartford Geriatrics Health Outcomes Research Scholars award, she's leading a study to evaluate screening mammography for the "oldest-old." Sponsored by the American Geriatrics Society's Foundation for Health in Aging and funded by the John A. Hartford Foundation, the two-year Hartford Outcomes awards are designed to support physician-scientists like Dr. Schonberg who are committed to improving the care of older adults while making the critical transition from junior faculty to independent researcher.

"My Outcomes award is making it possible for me to pursue research in my area of interest, which is preventive healthcare for older women," says Dr. Schonberg, who was one of four 2006 winners awarded $130,000 each in salary and research support over the course of two years. She is also the recipient of a 2007 American Geriatrics Society New Investigator Award for her research concerning the targeting of preventive health care services for older women.

With the support of her Outcomes award, Dr. Schonberg and colleagues have already reviewed the records of more than 2,300 women seen at Beth Israel and an affiliated community hospital between 1994 and 2006 and identified more than 300 who had abnormal mammography results or who developed breast cancer whether or not they had screening mammograms. By doing detailed chart reviews, drawing additional data from a national database that identifies causes of death, and analyzing this data they hope to clarify whether and when screening mammography offers a survival benefit for women 80 and up.

Some previous research suggests that the benefits of such screening are more likely to outweigh the risks for healthier women in this age group. These data also suggest that a woman 80 and older with breast cancer and multiple co-morbid diseases is more likely to die from those co-morbidities than from the cancer. Interestingly, additional data suggest that, after age 80, the biology of breast cancer changes and the cancer progresses more slowly than it does earlier in life.

"My goal is to be able to provide the kind of data that can help physicians decide whether a given patient would or would not benefit, data that can help physicians feel more comfortable talking to a patient about either stopping screening at a certain point, or, if the patient is generally healthy, suggest continued screening," Dr. Schonberg says. "I'm a general internist who sees women in this age category and I'd like to have this information myself. The idea here is to move toward more targeted, more rational use of mammography screening."

Hoping to expand on her Outcomes-funded research, Dr. Schonberg recently applied for a National Institute on Aging (NIA) grant that would allow her to draw on additional information -- from Medicare claims data -- regarding the 300 women she's studying. This information, on co-morbidity, cancer treatment, and socioeconomic factors, she notes, could further clarify which older women are most likely to benefit from screening mammography. The NIA has given her proposal a favorable review and a priority score of 127, which generally means it will be funded.

"Not only did my Outcomes Award enable me to undertake my research," Dr. Schonberg notes, "by enabling me to show a funding record, I think it has also helped me with my NIA grant."