PREVENTIVE
MEDICINE
Screening
20, 350-363 (1991)
Mammography Angeles
Rates and Barriers County Survey’
to Use: A Los
ROSHANBASTANI, PH.D.,**~ ALFRED C. MARCUS, PH.D.P, ANDREA HOLLATZ-BROWN, M.P.H.*
AND
*UCLA Jonsson Comprehensive Cancer Center, Division of Cancer Control, 1100 Glendon Avenue, Suite 711, Los Angeles, California 90024; and tAMC Cancer Research Center, Denver, Colorado
The use of screening mammographyamongwomen 40 years of age and older in Los Angeles County was assessed through a random digit dial telephone interview. The sample of 802 women represents a large urban population with substantial proportions of blacks, Hispanics, and Asians. The survey obtained information regarding adherence to the ACSI NC1 screening mammography guidelines, perceived benefits of early detection and mammography, perceived threat of developing breast cancer, and barriers to utilization. The results showed that 71% of the women had had at least one mammogram, with 49% having received a screening mammogram according to the guidelines for their age. Less than half the respondents knew the screening guidelines for their age, with women ages 40-49 years being less knowledgeable than women 350 years old (29 vs 58% answering correctly). A logistic regression analysis predicting the likelihood of having obtained a screening mammogram according to the guidelines found the following to be predictive: concern over radiation (negative association), age (negative association), family history, knowledge of guidelines, and cost of a mammogram (negative association). Other demographic factors and beliefs were not significantly related to this dependent variable. Q WI AC&~~C &SS, IIIC. INTRODUCTION Breast cancer has been a leading killer of women in this country for many decades (1, 2). Since there is no known way to prevent breast cancer, early detection offers the best immediate hope for reducing mortality from this disease, and mammography is considered the most accurate of the early detection techniques (3). Evidence indicates that population-based screening, using mammography, could reduce breast cancer mortality by as much as 30% (4-6). The National Cancer Institute, the American Cancer Society, and other major professional organizations recommended that women ages 40-49 years obtain a screening mammogram every 1 to 2 years and for women 50 years or older, an annual screening mammogram is recommended (7). Despite its proven effectiveness, mammography screening continues to be grossly underutilized. Surveys conducted before 1987 indicate that only about U-20% of women over 50 years of age reported being screened for breast cancer in the previous year (2, 8). More recent reports suggest that utilization may be increasing.
Data for 1987 from the Behavioral
Risk Factor Surveillance
System
show that, nationwide, 19% of women 350 years of age reported receiving a * Supported by Grant CA48439 from the National Cancer Institute to the first author. a To whom reprint requests should be addressed. 350 0091-7435/91$3.00 Copyright 0 1991 by Academic Press, Inc. AU rights of reproduction in any form reserved.
SCREENING
MAMMOGRAPHY
IN LOS ANGELES
351
screening mammogramin the previous year. The comparable figure for the state of California was 36% (9). Data for 1989 from Rhode Island show that 40% of women 240 years of age reported having a screeningmammogramin the past year (10). The Mammography Attitudes and Usage Study (MAUS) conducted in February 1990reported that, nationwide, 31% of women were being screened according to recommended guidelines (11). Studies with more limited samples have reported rates between 30 and 45% (12, 13). However, utilization of screening mammography still falls far short of the National Cancer Institute’s Year 2000goal of screening 80%.of all women over the age of 40. Numerous studies have revealed factors that may function as barriers or facilitators of participation in mammography screening. Among the most consistent barriers are cost of the procedure, lack of a recommendation from a physician, fear of radiation exposure, fear of a positive finding, lack of knowledge of the recommended guidelines, and believing that a mammogram is appropriate only when there are symptoms. Also, older women, those from less educated and lower income groups, and black and Hispanic women are less likely to be screened (2, 12, 14, 15). Currently, no data on screeningrates and barriers are available for Los Angeles County, which is a complex multiethnic metropolis with a population in excess of 7 million (16). Such estimatescan be very important for guiding planning activities with respect to screening programs in the county. Some surveys such as the 1987 Health Interview Survey and the 1987Behavioral Risk Factor Surveillance System provide national, regional, or statewide data. At the other end of the spectrum, data are available at the microlevel from studies targeting clinic populations and other special interest groups (17). Also, many of the available estimates of screening mammography rates are likely to be inflated because of the failure to distinguish between screening and diagnostic mammograms(8, 12, 13). Additionally, it is only recently that the American Cancer Society, the National Cancer Institute, and other major medical organizations reached a consensus on the recommended frequency of screening mammogramsfor women
MEDICINE
Screening
20, 350-363 (1991)
Mammography Angeles
Rates and Barriers County Survey’
to Use: A Los
ROSHANBASTANI, PH.D.,**~ ALFRED C. MARCUS, PH.D.P, ANDREA HOLLATZ-BROWN, M.P.H.*
AND
*UCLA Jonsson Comprehensive Cancer Center, Division of Cancer Control, 1100 Glendon Avenue, Suite 711, Los Angeles, California 90024; and tAMC Cancer Research Center, Denver, Colorado
The use of screening mammographyamongwomen 40 years of age and older in Los Angeles County was assessed through a random digit dial telephone interview. The sample of 802 women represents a large urban population with substantial proportions of blacks, Hispanics, and Asians. The survey obtained information regarding adherence to the ACSI NC1 screening mammography guidelines, perceived benefits of early detection and mammography, perceived threat of developing breast cancer, and barriers to utilization. The results showed that 71% of the women had had at least one mammogram, with 49% having received a screening mammogram according to the guidelines for their age. Less than half the respondents knew the screening guidelines for their age, with women ages 40-49 years being less knowledgeable than women 350 years old (29 vs 58% answering correctly). A logistic regression analysis predicting the likelihood of having obtained a screening mammogram according to the guidelines found the following to be predictive: concern over radiation (negative association), age (negative association), family history, knowledge of guidelines, and cost of a mammogram (negative association). Other demographic factors and beliefs were not significantly related to this dependent variable. Q WI AC&~~C &SS, IIIC. INTRODUCTION Breast cancer has been a leading killer of women in this country for many decades (1, 2). Since there is no known way to prevent breast cancer, early detection offers the best immediate hope for reducing mortality from this disease, and mammography is considered the most accurate of the early detection techniques (3). Evidence indicates that population-based screening, using mammography, could reduce breast cancer mortality by as much as 30% (4-6). The National Cancer Institute, the American Cancer Society, and other major professional organizations recommended that women ages 40-49 years obtain a screening mammogram every 1 to 2 years and for women 50 years or older, an annual screening mammogram is recommended (7). Despite its proven effectiveness, mammography screening continues to be grossly underutilized. Surveys conducted before 1987 indicate that only about U-20% of women over 50 years of age reported being screened for breast cancer in the previous year (2, 8). More recent reports suggest that utilization may be increasing.
Data for 1987 from the Behavioral
Risk Factor Surveillance
System
show that, nationwide, 19% of women 350 years of age reported receiving a * Supported by Grant CA48439 from the National Cancer Institute to the first author. a To whom reprint requests should be addressed. 350 0091-7435/91$3.00 Copyright 0 1991 by Academic Press, Inc. AU rights of reproduction in any form reserved.
SCREENING
MAMMOGRAPHY
IN LOS ANGELES
351
screening mammogramin the previous year. The comparable figure for the state of California was 36% (9). Data for 1989 from Rhode Island show that 40% of women 240 years of age reported having a screeningmammogramin the past year (10). The Mammography Attitudes and Usage Study (MAUS) conducted in February 1990reported that, nationwide, 31% of women were being screened according to recommended guidelines (11). Studies with more limited samples have reported rates between 30 and 45% (12, 13). However, utilization of screening mammography still falls far short of the National Cancer Institute’s Year 2000goal of screening 80%.of all women over the age of 40. Numerous studies have revealed factors that may function as barriers or facilitators of participation in mammography screening. Among the most consistent barriers are cost of the procedure, lack of a recommendation from a physician, fear of radiation exposure, fear of a positive finding, lack of knowledge of the recommended guidelines, and believing that a mammogram is appropriate only when there are symptoms. Also, older women, those from less educated and lower income groups, and black and Hispanic women are less likely to be screened (2, 12, 14, 15). Currently, no data on screeningrates and barriers are available for Los Angeles County, which is a complex multiethnic metropolis with a population in excess of 7 million (16). Such estimatescan be very important for guiding planning activities with respect to screening programs in the county. Some surveys such as the 1987 Health Interview Survey and the 1987Behavioral Risk Factor Surveillance System provide national, regional, or statewide data. At the other end of the spectrum, data are available at the microlevel from studies targeting clinic populations and other special interest groups (17). Also, many of the available estimates of screening mammography rates are likely to be inflated because of the failure to distinguish between screening and diagnostic mammograms(8, 12, 13). Additionally, it is only recently that the American Cancer Society, the National Cancer Institute, and other major medical organizations reached a consensus on the recommended frequency of screening mammogramsfor women
