The problem is the suggestion that interval tumors may represent histology of greater malignant potential, so that a four year interval may miss these tumors when they are pre-clinical. One simulation indicates that annual mammography results in added days of life regardless of age. 34 Recommendations Mammography Physicians should strongly consider recommending annual or at least biennial mammography until age 75 and biennially or at least every three years thereafter with no upper age limit for women with an estimated life expectancy of four or more years. The decision to undergo screening is ultimately each woman s choice. The physician s obligation is to offer screening in a positive manner, to explore women s individual concerns about the test and jointly decide with her how to proceed.
Life expectancy is an important factor in screening decisions.
Four year mortality is increased among women with moderately severe and severe dementia and among women experiencing progressive functional decline. The evaluation of these factors should enter decisions about screening. Nursing home residence per se is not a contraindication to mammography for women who possess the decisional capacity, functional and co-morbidity profiles to benefit. There is no new evidence on the efficacy of CBE, however clinical breast examination is covered by Medicare and costs little in terms of physician time and effort. It is recommended to be performed annually.