Abstract
Many factors influence women's decisions to participate in guideline-recommended screening mammography. We evaluated the influence of women's socioeconomic characteristics, health-care access, and cultural and psychological health-care preferences on timely mammography screening participation. A random digit dial survey of United States non-Hispanic Black, non-Hispanic White, and Hispanic women aged 40-75, from January to August 2009, determined self-reported time of most recent mammogram. Screening rates were assessed based on receipt of a screening mammogram within the prior 12 months, the interval recommended at the time by the American Cancer Society. Thirty-nine percent of women reported not having a mammogram within the last 12 months. The odds of not having had a screening mammography were higher for non-Hispanic White women than for non-Hispanic Black (OR = 2.16, 95% CI = 0.26, 0.82, p = 0.009) or Hispanic (OR = 4.17, 95% CI = 0.12, 0.48, p = 0.01) women. Lack of health insurance (OR = 3.22, 95% CI = 1.54, 6.73, p = 0.002) and lack of usual source of medical care (OR = 3.37, 95% CI = 1.43, 7.94, p = 0.01) were associated with not being screened as were lower self-efficacy to obtain screening (OR = 2.43, 95% CI = 1.26, 4.73, p = 0.01) and greater levels of religiosity and spirituality (OR = 1.42, 95% CI = 1.00, 2.00, p = 0.05). Neither perceived risk nor present temporal orientation was significant. Odds of not having a mammogram increased if women were uninsured, without medical care, non-Hispanic White, older in age, not confident in their ability to obtain screening, or held passive or external religious/spiritual values. Results are encouraging given racial disparities in health-care participation and suggest that efforts to increase screening among minority women may be working.
Highlights
Since the introduction of mammography and the availability of more effective treatments, more than 60% of breast cancers are diagnosed at localized stages, resulting in a greater likelihood of higher 5-year survival rates [1]
Our study aimed to explore the role of socioeconomic characteristics, health-care access, and cultural and psychological health-care preferences for cancer prevention and control on the prevalence of annual mammography screening in a national sample of racially diverse women in the United States (US)
Our study is the first to evaluate the prevalence of not having a mammogram within the last 12 months based on socioeconomic characteristics, health-care access, and cultural and psychologically based preferences for cancer prevention and control in a national sample of racially diverse women
Summary
Since the introduction of mammography and the availability of more effective treatments, more than 60% of breast cancers are diagnosed at localized stages, resulting in a greater likelihood of higher 5-year survival rates [1]. Further gains in 5-year survival may depend on increasing participation in mammography screening, improving our understanding of the role of genetics and of genetic screening, and developing more effective screening technology and treatment Women and their health-care providers may find it difficult to share in informed decision-making about mammography screening given ongoing differences in approaches to assessing individual risk as defined by breast density and/or family history and in recommendations by various guideline developers regarding the appropriate age to begin screening, the periodicity of screening, and the value of different screening modalities [2,3,4]. Prior work suggests that motivators include women’s awareness of the need for screening and of screening guidelines [7, 8], systems barriers to their utilization of screening services, and multidimensional personal preferences including psychological variables such as perceived risk of developing cancer as well as self-efficacy and culturally based values related to religion and spirituality, interpersonal relationships, autonomy, and temporal orientation (e.g., the extent to which individuals are concerned about the immediate or future consequences of behavioral options) [9, 10]
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