Nationwide cross-sectional adherence to mammography screening guidelines: national behavioral risk factor surveillance system survey results.

Abstract

Varying recommendations about breast cancer screening have generated much confusion about when and how often to undergo mammography screening, yet there is limited population-based data about the extent to which patients adhere to various mammographic screening guidelines in practice. Our purpose was to evaluate population-based adherence to mammographic screening using criteria from major guideline-producing organizations. Women aged 40-74 in the 2014 Behavioral Risk Factor Surveillance System survey were included. Self-reported mammographic screening within 1 or 2years, according to major guideline-producing organizations (American Cancer Society [ACS], US Preventative Services Task Force [USPSTF], American College of Radiology [ACR], American College of Obstetricians and Gynecologists [ACOG]) was calculated with logistic regression, adjusting for demographics and indices of access to health care. 159,123 women were included. By age category, cross-sectional adherence to USPSTF guidelines ranged from 76 to 81%, ACS (55-81%) and ACR/ACOG (45-64%) with increasing age being associated improved adherence. The highest proportions of women undergoing mammographic screening were seen in women ages 65-69 (66% within last year, 81% within last 2years). Statistically significant predictors of adherence to mammography screening included increased income category (OR 1.08, 1.07-1.09), higher education category (OR 1.13, 1.11-1.16), and increased access to health care (OR 2.25, 1.94-2.60), adjusted for age categories. Adherence to mammography screening was closest to USPSTF guidelines with 76-81% cross-sectional adherence. Frequency of screening increases with age with highest screening proportions in women ages 65-69 (66% within last year, 81% within last 2years). For all screening guidelines, adherence to mammography screening remains poor in women with limited access to health insurance with less than half of women obtaining recommended screening.