BACKGROUND: Even organizations with differing mammography recommendations agree that regular repeat screening is required for mortality reduction. However, most studies have focused on one-time screening rather than repeat adherence. We compare trends in beliefs and health-related behaviors among women screened and adherent to the National Cancer Institute’s screening mammography recommendations (on schedule), those screened at least once and nonadherent (off schedule), and those never screened.
METHODS: Our data are from a baseline telephone interview conducted among 1287 female members of Blue Cross Blue Shield of North Carolina who were aged either 40 to 44 years or 50 to 54 years.
RESULTS: The 3 groups differed significantly on beliefs and health-related behaviors, with the off-schedule group almost consistently falling between the on-schedule and never screened groups. Off-schedule women were more likely than on-schedule women, but less likely than those never screened, to not have a clinical breast examination within 12 months, to be ambivalent about screening mammography, to be confused about screening guidelines, and to not be advised by a physician to get a mammogram in the past 2 years. Off-schedule women perceived their breast cancer risk as lower and were less likely to be up to date with other cancer screening tests.
CONCLUSIONS: Our findings suggest that women who are off schedule are in need of mammography-promoting interventions, including recommendations from and discussion with their health care providers. Because they are more positive and knowledgeable about mammography than women who have never been screened, they may benefit from brief interventions from health care providers that highlight the importance of repeat screening.
Because most research has shown that routine mammography screening saves lives,1,2 many medical organizations have developed guidelines and recommendations for mammography screening. For example, the National Cancer Institute (NCI) recommends mammograms every 1 to 2 years for women aged 40 years and older and annual screening for women aged 50 years and older. Other organizations, such as the United States Preventive Health Task Force and the American College of Preventive Medicine, differ from the NCI regarding optimal screening intervals, but all agree on the importance of regular screening to achieve a breast cancer mortality reduction benefit.
However, despite these recommendations and substantial increases in the percentage of women who have ever had mammograms, most women are not having regular screening at recommended intervals. There is also still a group of women who have never been screened.3-6 For the purpose of developing interventions to encourage routine screening, it may be important to understand differences among women who are and are not getting repeat screening and those who have never been screened. However, with a few exceptions,7-12 most mammography studies have focused on 1-time screening rather than repeat adherence. Few studies have identified factors that predict repeat mammography use according to recommended guidelines.
For our analysis we sought to better understand factors that differentiate 3 groups of insured women: those who have been screened and are adherent to the screening mammography guidelines of the NCI, those screened at least once but who are currently nonadherent, and those never screened. Study findings should guide the design of interventions to promote continued adherence for repeat screening mammography.
Methods
Study Population
We randomly selected 2165 women from a sampling frame of 4000 women aged 40 to 44 years and 50 to 54 years who were members of the Personal Care Plan of Blue Cross Blue Shield of North Carolina (BCBS of NC) in 1997. We stratified the sample by age and mammography compliance status. Women with previous breast cancer and those who were no longer BCBS members were excluded from the sample. The completion rate for the telephone interviews was 76%, and the nonresponse rate was 20%, leaving a sample of 1287 women.
We mailed introductory letters, and professional interviewers conducted telephone interviews between November 1997 and May 1998. The participants provided oral consent in accordance with regulations from the Department of Health and Human Services. The analyses reported in this paper were conducted on baseline data collected for a larger intervention trial designed to enhance informed decision making about mammography. Additional details regarding our study methodology have been published elsewhere.13
Measures
Screening History Measure. The main variable of interest was self-reported mammography history (including most recent and previous mammograms). We calculated 2 screening variables reflecting whether: (1) the most recent mammogram was within the recommended time frame according to NCI recommendations, and (2) the interval between the most recent and the previous mammography date was within the recommended time frame for the woman’s age. The second interval could be computed only for women with more than 1 previous mammogram.