The efficacy of screening mammography has been well documented compared with most preventive practices, but the test remains poorly implemented in this country, especially in older women. Commonly cited reasons for this fact include lack of physician or patient education, expense, discomfort, and concern about radiation exposure.¹ We believe that, in addition, the underutilization of screening mammography illustrates a more global problem operating in the medical care of elderly patients, the deficit of data regarding many aspects of health care in the elderly, particularly for preventive and screening practices. In the case of screening mammography, the impact of the lack of efficacy studies in the elderly was exacerbated by a system whereby one arm of the federal government (in this case the National Cancer Institute [NCI]) makes health care recommendations while another arm (in this case the Health Care Financing Administration [HCFA]) determines what will be reimbursed. In this