Mammographic screening: Patterns of use and estimated impact on breast carcinoma survival

Abstract

BACKGROUNDAlthough many studies support the life‐saving potential of screening mammography, the actual utilization of screening and the impact of the actual pattern of screening use on the breast carcinoma death rate, remain incompletely understood. In the current report, the authors describe patterns of screening use among women who were examined at a large screening and diagnostic service and estimate the added mortality associated with missed screening mammograms.METHODSMammography use was assessed in a population of 72,417 women who received a total of 254,818 screening mammograms at the Massachusetts General Hospital (MGH) Avon Comprehensive Breast Center (Boston, MA) between January 1, 1985, and February 19, 2002. A computer simulation of breast carcinoma growth, spread, and detection of breast carcinoma was used to estimate the likely health consequences of various types of screening use.RESULTSBoth prompt return for annual screening and full use of screening over extended periods of time were rare, and comparison of the MGH population with other populations revealed that the low level of use observed in the MGH population was not atypical. Only 6% of women who received a mammogram in 1992 received all annual mammograms that were available over the next 10 years; the mean number of mammograms received during this period was 5.06, or 51% of the number recommended by the American Cancer Society. Computer simulation results indicate that this underutilization of screening should result in higher mortality levels. Women from traditionally underserved socioeconomic, racial, and ethnic groups, women without insurance, and women who did not speak English had lower levels of use compared with other women. Lower levels of use also were observed among women receiving their first mammogram or who in the past had not returned promptly. Women ages 55–65 years had higher levels of use than did younger or older women. Women who previously had breast carcinoma also had higher levels of screening use. Nonetheless, none of the subpopulations of women stratified by age, race, ethnicity, zip code, income,language, insurance, status, previous screening use, or medical history exhibited a widespread propensity to promptly return for annual screening over an extended period of time.CONCLUSIONSBy many measures, the current analysis is one of the most detailed descriptions of screening use to date. The authors observed a level of screening use that was disappointingly low, with potentially negative health‐related consequences, among women across categories defined by racial, ethnic, socioeconomic, and geographic characteristics; insurance status; language; age; medical history; and previous screening use. Improvements in the promptness with which women return to screening appear to have the potential to lead to considerable reductions in breast carcinoma death. Cancer 2004. © 2004 American Cancer Society.

Prevalence and predictors of cancer screening among American Indian and Alaska native people: the EARTH study

“…The relationship was not seen for mammography. Studies in other populations have found that those who speak a language different than English at home tend to have lower breast and cervical cancer screening prevalences, although similar findings have not been reported for American Indian and Alaska Native populations [7,26,27]. Examining predictive factors specific to Alaska and to the Southwest revealed that the finding was most apparent in Alaska.…”

A study to assess the knowledge regarding breast cancer and practices of breast self-examination among women in urban area

“…However Mammography findings were normal in all these individuals. [15][16][17] This study showed that more than 50% of the women were informed about BSE and its importance and its trends with respect to age, heredity and early detection.…”

Correlates of Repeat and Recent Mammography for Women Ages 45 to 75 in the 2002 to 2003 Health Information National Trends Survey (HINTS 2003)

“…A review of data on repeat mammography found that in studies whose participants had an on-schedule recent mammogram, at least 70% went on to obtain subsequent on-schedule exams (2). A report by Blanchard et al (14) also found that having a prior on-schedule mammogram was associated with a higher rate of repeat screening than for women without one on record. On the one hand, past behavior is generally a strong predictor of future behavior.…”

“…Thus, estimates ranged from as low as 28% (3,4) to as high as 92% (5). Studies since that review continue to report varying rates of repeat mammography, even when there were different subgroups examined in a single report: 45% and 49% (6); 67% and 74% (7); 73.4% (8); 29.9% and 35.8% (9); a range of 33% to 67.5% across six samples (10); 72.4% and 81.5% (11); 41% (12); 41.4% (13); 16%, 42%, and 63% (14); 79.8% (15); and 44% and 65% (16). The differences among these rates both within and between studies are due to their different samples and sampling frames, which are often local; the definitions of repeat mammography, including different intervals allowed between exams; and sometimes long elapsed times between when data were collected and when publication occurred, which does not account for secular trends during the elapsed time before publication.…”