S. C. Pawar1, R. S. Chamberlain1 1Saint Barnabas Medical Center,Surgery,Livingston, NJ, USA
Introduction: Breast cancer screening guidelines for women between age 40 and 49, 50 and 74, and over 75 years of age are variable. Controversies exist as to the effectiveness and potential risk associated with screening among different age groups and important predictors of mammography remains unclear. The study sought to determine breast cancer screening rates among US women of various ages, identify factors predictive of adherence to mammographic screening guidelines, and determination of the impact of physician recommendation.
Methods: The National Health Interview survey database was queried to identify female patients who underwent a screening mammography between 2008 and 2010. Univariate and multivariate logistic regression models were used to identify predictors of mammography.
Results:The median age of the study cohort was 53 yr. Among 11,312 women surveyed, and 8,155 (72%) had undergone a mammogram. Women undergoing mammographic screening were significantly older than women did not undergo a mammogram (53 Vs 39; P < 0.001). The high to low possibility of women undergoing mammographic screening were age 50-74 years followed by ≥ 75 years (85%), and 40-49 years (77%) and < 40 years (27%). 74% of this cohort were Caucasians, 18% African Americans, 0.8% Asians and 2% other races. 86% of women had insurance coverage for mammographic screening while 14% lacked any insurance coverage. Overall 53% of the uninsured received a mammogram. Northeastern region had the highest percentage of women screened; however there were no significant geographic differences. Mammographic screening was completed by 59% of women in whom it was recommended by physicians and by 75% in whom it was recommended by their designated primary care provider (p < 0.01). The percentage of women undergoing mammographic screening dropped from 78% (2008) to 76% (2010) over the study period and this was significant across women of all age groups except those < 40 years. The strongest predictors of completing mammography were physician recommendation, a designated primary care provider recommendation, adherence with annual breast examination, race/ethnicity, insurance type, and income status. The strongest association between physician recommendation and undergoing mammography was in the youngest age group women (OR: 20; 95% CI 15-27). Among women < 40 years for whom a mammogram was recommended by the physician, 23% had a history of BRCA1/BRCA2 gene mutation, while 34% reported of a family history of breast cancer.
Conclusion:A decrease in mammography screening among women of all age groups was observed during the study period and was most conspicuous in younger women. Explanations are likely multifactorial, but may be related to implementation of the USPSTF (United States prevention services task force). Barriers to mammography identified included the absence of physician recommendation, lack of a designated primary care provider, lack of adherence to annual breast examination, racial minorities, lower socioeconomic status, decreased education level and deprived insurance status. Physician recommendation is the strongest predictor of mammographic screening among patients compliant in all age groups, although there may be over recommendation of mammography among those > 70 years and < 40 years.
