As the number and proportion of elderly individuals in the US increases over the coming decades, the chrronic health problems of this group will assume greater importance. Cancer is currently the second leading cause of death in the elderly. The available data on the epideniology of breast and cervical cancer indicate that substantial reductions in mortality fron these cancers could be achieved through improved access to early detection among elderly women. This research will explore methods to increase breast and cervical cancer screening in elderly women. First, an ecological analysis of late stage breast and cervical cancer among elderly women living in NYC will identify where screening prograns should be targeted, then individual analyses will be used to determine who to screen, and finally, an assessuent of behavioral barriers to early detection, coupled vith nurse practitioner-run screening program in public hospitals, will contribute to an understanding of how to improve the utilization of early cancer detection services by elderly women. Ultimately,such research could provide a model for public hospital cancer screening programs, improve the rate of early stage diagnosis, reduce mortality and improve quality of life for elderly women. The resources and training sites for this award are based at 3 institutions: 1) Montefiore Medical Center, Division of Geriatrics and, Department of Epidemiology; 2) Columbia School of Public Health, Divisions of Epidemiology and Sociomedical Sciences; and 3) The Nev York City Health and Hospital Corp.(NYC HHC), a large public hospital system. Training of clinical geriatric epidemiologists, specializing in cancer epidemiology, is critical to met the NCI year 2,000 cancer control objectives.
