Evidence shows that breast cancer screening
by mammography reduces mortality.1,2
Breast cancers detected early with screening mammography are less likely to metastasize to lymph nodes and more likely to be treated with breast conservation without chemotherapy.3
Despite the known benefits of annual or biannual screening mammography beginning at age 40 or 50,4
approximately 25%–50% of American women report not having a mammogram in the past 2 years.4,5
High variation in average rates of screening mammography adherence can be attributed to the lack of consensus about the efficacy of screening for women aged 40–49, variation in availability of screening facilities, and other factors that may disproportionately impact those residing in communities with fewer healthcare resources.6
Elting et al.7
documented that mammography facilities were available in only 49% of Texas counties. The likelihood of screening mammography in the previous 2 years was lowest for women living in counties without mammography facilities and those not adjacent to a county with a mammography facility.
Although interventions that use tailored messaging have shown promise for increasing rates of screening mammography, they are not effective for all groups of women.8,9
Effective tailoring remains a challenge in part because of the assortment of factors associated with the likelihood of adhering to screening guidelines, including demographic factors, relationships with providers, perceived health, health literacy, and access to facilities.10
Lower adherence to screening mammography guidelines has been documented among populations of low incomes, less education, younger and older ages, within rural or inner city communities, and of Hispanic and Asian ethnicity.11–15
The primary reason given by women for not having a mammogram is lack of a physician's recommendation.10,16–18
Other important barriers include lack of a usual healthcare source, inadequate health insurance coverage, and recent immigration.12,19,20
The likelihood of having screening mammography increases as the patient increases the number of physicians seen, number of appointments kept, and years of clinic attendance.11,21–24
Longer durations of patient-physician relationships and better communication between patients and physicians may improve knowledge and trust, which may result in an increased likelihood of adhering to screening mammography guidelines, along with other preventive services.25
However, the patient-physician relationship cannot be the sole target of interventions because many women, especially those in more rural areas, experience limited healthcare access, do not identify with a primary healthcare provider, or are affected by limited physician time in primary care settings.15,26–29
Although general barriers to screening mammography have been identified, less is known about the relationships of perceived health, healthcare access, and use of primary care services with screening mammography at different times among diverse populations within various settings. In addition, relatively little is known about screening mammography use by women in their 40s, which is an important topic to investigate given questions about the effectiveness of screening for women in their 40s at average risk for breast cancer.4,30–32
The primary purposes of this exploratory study were to (1) examine the screening mammography practices of middle-aged and older women residing in an eight-county area in Central Texas and (2) identify the personal demographics, perceived health status, and healthcare access factors associated with the time in which participants reported their most recent mammogram (i.e., having a mammogram in the past 12 months, having a mammogram between the past 1 and 2 years, and having a mammogram longer than the past 2 years).
At the time of this study, the American Cancer Society (ACS) recommended that women should receive annual screening mammography beginning at age 40 as long as they were in good health.4
The U.S. Preventive Services Task Force (USPSTF) previously recommended that women receive screening mammography every 1–2 years beginning at age 4033
; however, in November 2009, the USPSTF issued new recommendations calling for individualized decisions about screening mammography for women aged 40–49 and biennially from age 50 to 74.30
For the purpose of this study, we looked at mammography in the past 12 months (ACS recommendation), in the past 1–2 years (new USPSTF recommendation), and >2 years ago (not adherent to either ACS or USPSTF recommendations).