Breast cancer screening rates, especially for mammography, continue to lag for older women, particularly for women older than 65 years. The authors investigated the associations of key variables with reported rates of mammography and clinical breast examination in a sample of 972 women older than 50 years; 724 of them were older than 65 years. They were surveyed in late 1990 through 30-minute bilingual telephone interviews. Although it was hypothesized that race, age, health status, and physician-patient communication variables would influence utilization rates, only the communication variables (and two access variables) significantly predicted a recent mammogram or clinical breast examination. In particular, the style of communication--the patient's report of the physician's enthusiasm for mammography when it was discussed with women at the office visit--influenced the women's screening behavior significantly. Women who perceived that their physicians had some enthusiasm for mammography were more than four and a half times more likely than women whose physicians had no or little enthusiasm for mammography to have had a mammogram within the previous year. Other findings were that about half of the Los Angeles, Calif., women in this study reported a recent mammogram, an increase from the one third who reported one in the previous survey of 1988; a decline in screening was not reported until after age 75 years. About a quarter of the study women, on the other hand, had never been screened despite the long-standing recommendation for regular screening of women older than 50 years and the risk of breast cancer increasing with age. Surprisingly, women at higher risk of breast cancer were not being screened any more systematically than women at lower risk. The authors conclude that improved physician-patient communication skills could be a highly effective and easy-to-learn strategy to increase overall screening rates.