Older women whose life expectancy is less than five years are unlikely to benefit from screening mammography or Papanicolaou (Pap) smears. Since life expectancy is better predicted by health status than by age alone, guidelines recommend considering an older woman's general health when making screening decisions. The objective of the study was to determine whether screening mammography and Pap smears are targeted to healthy older women and are avoided in women with limited life expectancies. This cross-sectional population-based study gathered data from 4,792 women 70 years of age or older who participated in the California Health Interview Survey (CHIS) between November 2000 and October 2001. Predictor variables included age and health status.The main outcome was self-reported receipt of screening mammography within the previous two years and a screening Pap smear within three years.

Findings: Seventy-eight percent of women reported recent screening mammography, and 77% reported a recent Pap smear. Screening rates decreased with advancing age. However, within each age group, the percentage of women reporting screening did not significantly decrease with worsening health status. More than half of women 80 years of age or older in the worst health quartile reported recent screening, representing approximately 81,000 mammograms and 35,000 Pap smears.

Rates of recent screening mammography and Pap smears are high among older women in California. Although screening rates drop with advancing age, women in poor health do not avoid screening. Screening should be better targeted to healthy older women and should be avoided in women with limited life expectancies for whom risks of screening outweigh potential benefits.