Patient Barriers to Mammography Identified During a Reminder Program

Abstract

Background: Patient mammogram reminders are effective at increasing screening, but patient barriers remain. We evaluated patient characteristics and reported barriers for their association with mammogram completion after a reminder program. Methods: This retrospective cohort study used data from electronic records and a subgroup survey. Participants were female Kaiser Permanente Northwest health maintenance organization (HMO) members aged 50-69 who were 20 months past their last mammogram (index date) and had received a reminder intervention (n ¼ 4708). A mailed survey was completed by 340 of 667 (50.2%) women who received it. The intervention was a ''mammogram due soon'' postcard 20 months after the last mammogram, followed by up to two automated phone calls and one live call for nonresponders. The outcome was mammogram completion at 10 months after index date. Results: Characteristics associated with lower mammogram completion rates were aged <60 (odds ratio [OR] 0.69, p < 0.0001), health plan membership <5 years (OR 0.81, p ¼ 0.019), family income <$40,000=year (OR 0.77, p ¼ 0.018), and obesity (OR 0.67, p < 0.0001). Obese women were more likely than nonobese women to report ''too much pain'' from mammograms (31.3% vs.18.8%, p < 0.01). Younger women were more likely to endorse that they were ''too busy' ' (19.1% vs. 6.4%, p < 0.001) and had more worries about mammogram accuracy (2.5 vs. 2.3 on a 5-point scale, p < 0.05). Pain mediated the relationship between obesity and mammogram completion rates (indirect effect ¼ À0.111, p ¼ 0.008). Conclusions: Important barriers to mammogram completion remain even after an effective mammogram reminder system among insured patients. Tailored interventions are necessary to overcome these barriers.

The Impact of Obesity on Breast Cancer Diagnosis and Treatment

“…This was especially true in women with the highest BMI and in Caucasian women, but not in African American women. In looking at barriers to screening to mammography in women aged 50–69, a Kaiser Permanente study found that non-compliance was higher in obese women and that they were twice as likely to cite pain with the procedure as a reason for non-compliance [ 6 ].…”

Mammography Social Support for Women Living in a Midwestern City: Toward Screening Promotion via Social Interactions

“…For most women with private insurance, the cost of mammography is covered without copayments or deductibles, although women have to contact their mammogram facility and health insurance company for confirmation. Additionally, indirect costs exist (Feldstein et al, 2011) -both tangible (e.g., obtaining transport; absence from work, and childcare) and intangible (pain; cultural beliefs). Instrumental (e.g., providing transport; helping with childcare), emotional (e.g., reassuring against the fear of pain; discussing cultural beliefs) (Pedersen, Zachariae, Jensen, Christensen, & Lassesen, 2004), and appraisal (e.g., welcoming the decision to have mammography) supports often encourage women to overcome these barriers in critical times of decision making and adopt the behavior of regular screening.…”

Obesity and Breast Cancer: A Case of Inflamed Adipose Tissue

“…A few studies have shown a correlation between obesity and higher Tumor Node Metastastis (TNM) stage with increased lymph node involvement at time of diagnosis [ 58 , 64 ]. However, this association may be due to diagnostic difficulties and/or reduced adherence to mammographic screening recommendations in obese women [ 65 , 66 , 67 ]. Obesity is also associated with an increased risk of complications following surgical treatment of breast cancer [ 42 , 68 , 69 ].…”