Mammography and age: Are we targeting the wrong women? A community survey of women and physicians

Abstract

To determine mammography use among women with a broad range of ages, the authors surveyed women aged 30 to 74 years and physicians practicing primary care in two eastern North Carolina counties. Twenty-five percent of women in their 30s had ever had a mammogram, and 34% intended to have one in the coming year. From 45% to 52% of women in their 40s, 50s, and 60s had ever had a mammogram, and 55% to 57% intended to have one in the next year. Thirty-seven percent of women aged 70 to 74 years had ever had a mammogram, and 40% intended to have one in the following year. Nineteen percent of physicians reported screening nearly all women aged 30 to 39 years, and 14% screened few women aged 50 to 74 years. Younger women were more worried about breast cancer than older women and assessed their risk as higher, attitudes that were generally associated with higher mammography utilization. These community surveys suggest that mammography use may be excessive among younger women; older women continue to be underscreened. Cancer 67:2010-2014,1991, HE EVIDENCE for the usefulness of mammography T in screening women for breast cancer varies with age. For women aged 50 to 74 years, the evidence is strong,''2 and there is universal agreement among expert groups that these women should receive regular mamm~graphy.~-' For women in their 40s, the evidence is less clear,'-' ' and expert groups disagree in their screening recommendation^.^.^^^-^^'^ For women younger than 40 years of age, the low incidence of breast cancer13 and the low sensitivity of rnamm~graphy'~,'~ have led to a consensus that routine screening with mammography is not indicated. Few groups now recommend even a "baseline" mammogram for women younger than 40 years of age.I6 Several population surveys have assessed compliance with these recommendations among older women. Women aged 50 years and over have had less mammographic screening than is considered ideal.I7 Two recent surveys have found self-reported mammography use for women aged 40 to 49 years to be about the same as for older ~o m e n . '~, '~ No recent survey, however, has investigated mammography use by women aged 30 to 39 years. Also, although studies have examined the relationship between use of mammography and knowledge and attitudes about breast cancer, no study has investigated how these relationships might differ by a woman's age.We surveyed women and physicians practicing primary care in two eastern North Carolina counties to determine past and intended use of mammography among women aged 30 to 74 years. We asked whether knowledge and attitudes about breast cancer differed among women of different ages and whether these factors were associated with past use or intended use of mammography. To confirm these women's reports of mammography use, we questioned local physicians about their ordering of mammography for women in various age groups. 2010

Racial and Geographic Differences in Mammography Screening in St. Louis City: A Multilevel Study

“…Previous studies have reported individual-level risk factors and census-tract socioeconomic effect on mammography use. 7,8,[22][23][24][25][26][27]29,30,[32][33][34]43 In our study, system-level barriers to mammography and heavy smoking were associated with mammography use among white and African American women. Personal-experience barriers to mammography and no physician recommendation also were independently associated with mammography screening among white women.…”

“…Predisposing factors previously found to be associated with screening included age, 22 race/ethnicity, 23 education level, 24 marital status, and family history of breast cancer. Enabling resources associated with screening included family income, 24,25 employment status, health insurance coverage, barriers to seeing a doctor, having access to medical care when needed, 15,23,26 knowledge about breast cancer and mammography, [27][28][29] perceived barriers and benefits of mammography, [27][28][29][30][31][32] and having a physician recommend a mammogram during the past 2 years.…”

Measuring Perceptions of Breast Cancer Risk

“…For instance, many studies have assessed risk perception to test models that posit an association between risk perception and health behavior (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). Other research assesses risk perception to detect errors and biases in risk judgments (15)(16)(17)(18), to assess the association between risk judgments and emotion (19)(20)(21)(22)(23)(24)(25), and to increase the accuracy of people's risk perceptions (11,(26)(27)(28).…”

Psychosocial Factors Associated with the Use of Breast Cancer Screening by Women Age 60 Years or Over

“…[12][13][14][15][16] Even more important, participation in screening is lowest among older women. Women age 60 years or over generally are found to be less likely to ever have received mammograms and/or CBE and are less likely to have been recently screened.…”