Self-reported Mammography Use Research Articles

Breast cancer screening programmes and self-reported mammography use in European countries.

Mammography screening has been shown to be able to reduce breast cancer mortality, leading most European countries to implement mammography-based screening programmes. In our study, we analysed key characteristics of breast cancer screening programmes and mammography use in European countries. Information on screening programmes were obtained from the 2017 European Union (EU) screening report, websites from governments and cancer registries, and through literature search in PubMed (studies published up to 20 June 2022). Data on self-reported mammography use in the past 2 years were obtained from Eurostat and had been derived from the European health interview survey (cross-sectional survey), conducted in the 27 EU countries, Iceland, Norway, Serbia, Turkey and the UK in 2013 to 2015 and 2018 to 2020. Data were analysed for each country according to their human development index (HDI). By 2022, all included countries besides Bulgaria and Greece had introduced an organised mammography-based screening programme; Romania and Turkey had only pilot programmes. Screening programmes differ substantially across countries, particularly in timing of implementation (e.g., in Sweden, the Netherlands before 1990; Belgium, France between 2000 and 2004; Denmark, Germany between 2005 and 2009; Austria, Slovakia after 2010). Self-reported mammography use also differed considerably across countries, and went along with HDI-from <36% in all countries with HDI <0.85 to >70% in most countries with HDI >0.90. The data call for efforts to improve mammography screening use across Europe, particularly in countries with lower development levels where breast cancer mortality rates are also among the highest in the region.

Abstract A030: Empowering Latinas to obtain breast cancer screenings: Comparing intervention effects and cost effectiveness

Abstract Purpose: Latinas suffer disproportionately from breast cancer relative to non-Latina Whites, partially due to lower guideline-concordant screening. Multiple approaches are used to address this disparity including educational interventions and empowerment-related interventions, wherein a subset of the population is trained to share information with other members of the priority population. However, little is known about the relative effects of these different approaches. Objective: To analyze preliminary data regarding the effectiveness and cost-effectiveness of education and empowerment approaches. Methods: This ongoing, quasiexperimental trial is situated in two lower-income Latino communities in Chicago. Eligibility criteria include: 1) age of 52-74; 2) no mammography use within past 2 years; 3) no previous breast cancer diagnosis; and 4) no prior health volunteerism experience. Women are assigned to a cohort and participate in a three-week intervention (education: breast cancer, diet, physical activity; empowerment: breast cancer, sharing information with networks, health volunteerism). For women who wish to obtain mammography (from either arm), the study team provides navigation to free/low-cost services. Data collected at baseline, post-intervention, and six-month follow-up include standard demographics and self-reported mammography use, which are verified by study navigation records. The perspective for cost-effectiveness analyses was the community-based organization implementing the program. Cost data include overhead, non-personnel, and personnel costs (per task, per person encounter). Cost data were standardized to US dollars in 2018 and extrapolated to the duration of study implementation. Results: Our current sample is 97 women (51 education; 46 empowerment). Most women were 52-64 years old (70%), had insurance (58%), had less than a 9th grade education (60%), had an annual household income of &amp;lt;$15,000 (67%), and were born in Mexico (86%). More empowerment participants obtained a mammogram than education participants, after adjusting for age, education, income, insurance, mammography history, and mammography plans (47% vs. 74%; OR = 3.2, 95%CI [1.1, 9.00], p=.001). The empowerment intervention was also less expensive. The costs for education and empowerment interventions were $32,919 and $24,983 ($645 and $490 per person), respectively. Hence, empowerment appears to be a dominant strategy. Discussion: Empowerment approaches may be more effective and more cost effective in promoting mammography than education approaches among non-adherent Latinas. Limitations concern generalizability due a non-probability based sample, and limited ability for causal inferences due to a lack of randomization. Next steps include incorporating participants' costs and including unintended effects (e.g., number of non-participant women obtaining mammography). Citation Format: Yamile Molina, Liliana G. San Miguel, Catherine Pichardo, Genesis Rios, Leslie Diaz, Stephanie Cardenas, Esmeralda Cardoso-Mendoza, Juanita Arroyo, Maria Medina, Nora Coronado, Araceli Lucio, Olivia Hernandez, Surrey Walton. Empowering Latinas to obtain breast cancer screenings: Comparing intervention effects and cost effectiveness [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A030.

Abstract B011: Empowering Latinas to obtain breast cancer screenings: Comparing interventions’ behavioral and network effects

Abstract Purpose: Multiple approaches have been used to address Latinas’ disproportionate breast cancer burden, including educational interventions and empowerment related interventions, wherein a subset of the population is trained to share information with other members of the priority population. However, little work has compared their effects. Objective: To analyze data regarding the effectiveness of education and empowerment approaches on participant behaviors and network dissemination. Methods: This quasi-experimental trial was conducted in two lower-income Latino communities in Chicago between 2017-2019. Eligibility criteria include: 1) age of 52-74; 2) no mammography use within past 2 years; 3) no previous breast cancer diagnosis; and, 4) no prior health volunteerism experience. Women were assigned to a cohort and participate in a three-week intervention (education: breast cancer, diet, physical activity; empowerment: breast cancer, sharing information with networks, health volunteerism). For women who wished to obtain mammography (from either arm), the study team provided navigation to free/low-cost services. Data were collected at baseline, post-intervention, and six-month follow-up included standard demographics; self-reported mammography use, which were verified by study navigation records; and a modified version of Burt’s General Social Survey tool for egocentric data collection. All analyses accounted for cohort clustering and adjusted for relevant covariates (age, education, income, insurance status, baseline mammography intention, social network size, baseline proportion of network engaged about breast cancer). Results: There was a total of 145 women who enrolled in the study, of which 126 completed the intervention (64 empowerment, 62 education). Approximately 70% of participants were 52-64 years old, 57% were insured, 58% had less than a 9th grade education, had an annual household income of &amp;lt;$15,000 (44%), and 83% were born in Mexico. More empowerment participants had greater odds of obtaining a mammogram relative to education participants, 47% vs 84%; OR = 6.1, 95%CI [2.3, 15.5], p&amp;lt;.0001. Simultaneously, relative to education participants, empowerment participants talked to more women about breast cancer (M = 5.4 SD = 4.7 vs M= 2.6, SD = 2.6; Std B = 2.7, 95%CI [1.3, 4.0], p&amp;lt;.0001) as well as had greater odds of endorsing a specific type of breast cancer screening (69% vs 39%, OR = 3.6, 95%CI[1.7, 7.4], p =.001) and disseminating breast cancer information in public locations (48% vs 23%, OR = 3.2, 95%CI [1.6, 6.7], p = .002). Discussion: Empowerment approaches appear to be more effective at promoting mammography among non-adherent Latinas and enabling community-wide dissemination of evidence-based breast health information, when compared to education approaches. Limitations concern generalizability due a non-probability based sample, and limited ability for causal inferences due to a lack of randomization. Citation Format: Yamilé Molina, Liliana G. San Miguel, Catherine Pichardo, Genesis Rios, Juanita Arroyo, Maria Medina, Nora Coronado, Araceli Lucio, Olivia Hernandez. Empowering Latinas to obtain breast cancer screenings: Comparing interventions’ behavioral and network effects [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B011.

Breast Cancer Screening in Puerto Rico and Other US Territories: Findings from the 2016 Behavioral Risk Factor Surveillance System Survey

Initial studies suggest that women living in U.S. territories may experience barriers to appropriate breast cancer diagnosis and treatment. Our purpose was to evaluate mammography screening engagement in U.S. territories compared with U.S. states. Women aged 50-74 years in the 2016 Behavioral Risk Factor Surveillance System survey without personal history of breast cancer were included. Proportions of women reporting mammography use were calculated. Multivariable logistic regression models were used to compare self-reported mammography use in U.S. territories with all U.S. states. Our total study population included 131,320 women. Of this group, 2,481 were from U.S. territories. In our adjusted analyses, women in the U.S. Virgin Islands were less likely to report mammography use (OR 0.52) compared with women in the U.S. states. Women in other U.S. territories reported mammography at similar rates to U.S. states. Targeted interventions accounting for unique, territory-specific barriers are likely required to improve screening engagement.

Obesity and breast cancer screening: Cross-sectional survey results from the behavioral risk factor surveillance system.

Postmenopausal obese women demonstrate an elevated breast cancer risk and experience increased breast cancer morbidity and mortality compared with women with a normal body mass index (BMI). However, to the authors' knowledge, prior studies have yielded inconclusive results regarding the effects of obesity on mammography screening adherence. Using national cross-sectional survey data, the objective of the current study was to assess the current association between increasing BMI and use of mammography screening. Cross-sectional survey data from the 2016 Behavioral Risk Factor Surveillance System, a state-based national telephone survey of noninstitutionalized adults in the United States, was used to identify the association between mammography screening use and increasing incremental BMI categories, including normal (18.5-24.9kg/m2 ), overweight (25-29.9kg/m2 ), obese class I (30-34.9kg/m2 ), obese class II (35-39.9kg/m2 ), and obese class III (>40kg/m2 ), with adjustments for potential confounders. A multivariable logistic regression model was used to evaluate the effect of each BMI category on self-reported mammography use, using unadjusted and adjusted odds ratios. Effect modification by race/ethnicity was determined by testing interaction terms using Wald tests. Of 116,343 survey respondents, 33.5% (38,984 respondents) had a normal BMI, 32.6% (37,969 respondents) were overweight, 19.3% (22,416 respondents) were classified as obese class I, 8.4% (9791 respondents) were classified as obese class II, and 6.2% (7183 respondents) were classified as obese class III. There was no statistically significant difference (P<.05) observed with regard to mammography use between women with a normal BMI and obese women from each obese class (classes I-III) when compared individually. There also was no evidence of effect modification by race (P=.53). In contrast to prior reports, the results of the current study demonstrated no association between obesity and adherence to screening mammography. These findings may relate to the increasing social acceptance of obesity among women from all racial/ethnic groups and the removal of weight-related facility-level barriers over time.

Trends in the use of mammography for early breast cancer detection in Switzerland: Swiss Health Surveys 2007 and 2012.

Breast cancer is the most common cancer in women worldwide. We assessed changes in the use of breast cancer screening 2007-2012 in Switzerland, and associations with socioeconomic and health-related determinants. We used the nationwide and representative data from the Swiss Health Surveys 2007 and 2012. We analysed the self-reported use of mammography in the last 12 months (proportion of population) among women aged 40-79 years, and opportunistic (without clinical symptoms, initiated by the woman or a physician) and programmatic screening mammography (as part of a systematic screening programme). We performed multivariate logistic regression analyses (presented as adjusted odds ratios, aORs). The use of any mammography in the last 12 months declined from 19.1% (95% confidence interval [CI] 17.7-20.5%) in 2007 to 11.7% (95% CI 10.7-12.6%) in 2012. This decline was more pronounced in regions with a long-standing or no cantonal breast cancer screening programme (aOR 0.5, 95% CI 0.4-0.6, and aOR 0.5, 95% CI 0.4-0.6, respectively), but remained relatively stable in regions with a recently introduced programme (aOR 0.9, 95% CI 0.6-1.3, p-value from test for interaction 0.01). Opportunistic screening dropped from 12.0% (95% CI 10.9-13.2%) in 2007 to 6.2% (95% CI 5.5-6.9%; p <0.001) in 2012, whereas the use of programmatic mammography remained stable at 3.1% (95% CI 2.6-3.7%). Use of any mammography was higher in women aged 50-69 years, residing in a region with a systematic screening programme in place, and women having a private hospital stay insurance, but was not associated with education level and non-Swiss citizenship. Overall attendance of breast cancer screening is low in Switzerland and decreased between 2007 and 2012, despite expanding cantonal mammography screening programmes. Many factors may have contributed to this decline, including the ongoing scientific and public debates on the value of breast cancer screening.

Validating self-reported mammography use in vulnerable communities: findings and recommendations.

Most health surveys ask women whether they have had a recent mammogram, all of which report mammography use (past 2 years) at about 70% to 80% regardless of race or residence. We examined the potential extent of overreporting of mammography use in low income African-American and Latina women, and whether self-report inaccuracies might bias estimated associations between patient characteristics and mammography use. Using venue-based sampling in two poor communities on the west side of Chicago, we asked eligible women living in two west side communities of Chicago to complete a survey about breast health (n = 2,200) and to provide consent to view their medical record. Of the 1,909 women who screened eligible for medical record review, 1,566 consented (82%). We obtained medical records of all women who provided both permission and a valid local mammography facility (n = 1,221). We compared the self-reported responses from the survey with the imaging reports found in the medical record (documented). To account for missing data, we conducted multiple imputations for key demographic variables and report standard measures of accuracy. Although 73% of women self-reported a mammogram in the last 2 years, only 44% of self-reports were documented. Overreporting of mammography use was observed for all three ethnic groups. These results suggest considerable overestimation of prevalence of use in these vulnerable populations. Relying on known faulty self-reported mammography data as a measure of mammography use provides an overly optimistic picture of utilization, a problem that may be exacerbated in vulnerable minority communities.

Accuracy of Self-Reported Screening Mammography Use: Examining Recall among Female Relatives from the Ontario Site of the Breast Cancer Family Registry

Evidence of the accuracy of self-reported mammography use among women with familial breast cancer risk is limited. This study examined the accuracy of self-reported screening mammography dates in a cohort of 1,114 female relatives of breast cancer cases, aged 26 to 73 from the Ontario site of the Breast Cancer Family Registry. Self-reported dates were compared to dates abstracted from imaging reports. Associations between inaccurate recall and subject characteristics were assessed using multinomial regression. Almost all women (95.2% at baseline, 98.5% at year 1, 99.8% at year 2) accurately reported their mammogram use within the previous 12 months. Women at low familial risk (OR = 1.77, 95% CI: 1.00–3.13), who reported 1 or fewer annual visits to a health professional (OR = 1.97, 95% CI: 1.15, 3.39), exhibited a lower perceived breast cancer risk (OR = 1.90, 95% CI: 1.15, 3.15), and reported a mammogram date more than 12 months previous (OR = 5.22, 95% CI: 3.10, 8.80), were significantly more likely to inaccurately recall their mammogram date. Women with varying levels of familial risk are accurate reporters of their mammogram use. These results present the first evidence of self-reported mammography recall accuracy among women with varying levels of familial risk.

Self-reported mammography use following BRCA1/2 genetic testing may be overestimated

Adherence to mammographic screening recommendations following BRCA1/2 testing is generally assessed through self-reports. However, the validity of self-reported mammography by women who had undergone BRCA1/2 genetic testing is still unknown. This study aimed to assess the validity of self-reported mammography use in the past 12 months among women who had undergone BRCA1/2 testing. Using a self-administered questionnaire, 307 women who never had cancer were asked 1 year following BRCA1/2 test result disclosure whether they undergone a mammography in the past 12 months. For each participant, this information was compared to that provided by the Quebec Health Insurance Board administrative data set for mammography claims during the same period, here considered as the gold standard. Sensitivity (Sn), specificity (Sp), predictive values, and Cohen's kappa (κ) were calculated. The robustness of these estimates was assessed using sensitivity analysis in which we varied the administrative data time lapses up to 18 months. Overall, the agreement between self-reports and administrative data was 88% (κ = 0.74). Among the 180 participants who had a mammography according to the administrative data, 172 adequately reported this information (Sn = 96%). Sp was moderate (76%), meaning that 24% of those who did not have a mammography reported one. Extending the time lapses to 18 months increased the Sp substantially (Sp = 90%). Self-report overestimates the use of mammography, mainly because women tend to minimize the elapsed time since their last mammography. Self-reports should be used cautiously to assess adherence to mammographic screening following BRCA1/2 testing.

Factors that influence mammography use and breast cancer detection among Mexican-American and African-American women.

This study examined factors that influence mammography use and breast cancer detection, including education, health insurance, and acculturation, among Mexican-American (MA) and African-American (AA) women. The study included 670 breast cancer cases (388 MAs and 282 AAs), aged 40-86 years at diagnosis. Data on mammography use, detection, and delay in seeking care were collected via questionnaires and medical records. Using a language-based bidimensional acculturation measure, MAs were classified as English-dominant (n = 67), bilingual (n = 173), and Spanish-dominant (n = 148). Mammography prior to diagnosis was assessed by racial/ethnic acculturation subgroup using logistic regression. In age-adjusted models, mammography use was non-significantly lower among English-dominant (OR = 0.84; 95% CI: 0.45-1.59) and bilingual (OR = 0.86; 95% CI: 0.55-1.35) MAs and significantly lower among Spanish-dominant MAs (OR = 0.53; 95% CI: 0.34-0.83) than among AA women. After adjustment for education or insurance, there was no difference in mammography use by race/ethnicity and acculturation subgroup. Despite high self-reported mammography use (75%), a large proportion of cases reported self-detection (59%) and delay in seeking care >90 days (17%). These findings favor promoting culturally appropriate messaging about the benefits and limitations of mammography, education about breast awareness, and prompt reporting of findings to a health professional.

Factors Associated with Self-Reported Mammography Use for Women With and Women Without a Disability

Although their risk of breast cancer is similar to that of women without a disability, women with a disability might be less likely to obtain a mammogram within the recommended time frame. The purpose of this study was to expand our knowledge of the association between mammography use and having a disability by controlling for sociodemographic and health variables. Data from the 2008 Behavioral Risk Factor Surveillance System (BRFSS) were used to obtain prevalence of self-reported mammography use in the past 2 years among U.S. women ≥40 years of age (n=204,981) as well as women 50-74 years of age (n=122,374). Logistic regression was used to estimate associations between disability and obtaining a mammogram for each age cohort, controlling for sociodemographic factors. Prevalence of self-reported mammography use is lower for women with a disability (72.2% for women ≥40 years of age and 78.1% for women 50-74 years of age) than women without a disability (77.8% and 82.6%, respectively). Women with a disability had lower odds of mammography use than women without a disability for both age cohorts (≥40, adjusted odds ratio [aOR] 0.92, p=0.01; 50-74 years, aOR 0.92, p=0.03). Disparities in obtaining a mammogram at recommended screening intervals persist for women with disabilities. This demonstrates the need for continued health promotion and prevention activities directed toward women with a disability to improve their accessibility to obtaining a mammogram.

Use of Evidence-Based Strategies to Promote Mammography Among Medically Underserved Women

Several web-based resources recommend effective intervention strategies to promote use of mammography but there is limited information on whether the strategies are used, particularly by organizations that serve medically underserved women. In 2010, data collected by the Avon Breast Health Outreach Program (BHOP) were analyzed to examine the diffusion of evidence-based intervention strategies among funded organizations. Data on intervention strategies were obtained from a 2009 survey of Avon BHOP organizations funded during 2006-2009. Self-reported use of mammography was reported from annual intake forms administered to medically underserved women aged ≥40 years, excluding those with a history of breast cancer or initial enrollees not exposed to the strategies. Strategies reflected interventions reviewed in the Guide to Community Preventive Services. Those recommended to increase demand and use of mammography included (1) client reminders; (2) small media; (3) one-to-one education; (4) removal of structural barriers to rescreening; and (5) group education-and one that lacked sufficient evidence to warrant a recommendation (6) client incentives. Among 86 organizations, 96% used three or more intervention strategies. The most common strategies were group education (91%) and client reminders (83%). The overall crude-percentage of recent mammography use was 84%. This percentage was similar for clinical sites and nonclinical sites, despite the disproportionate enrollment of medically underserved women in nonclinical sites. The wide use of evidence-based strategies among Avon BHOP-funded organizations and high percentage of recent mammography use among women exposed to the strategies suggests that medically underserved women are benefiting from effective interventions to increase use of mammography.

Sensitivity of Self-Report Mammography Use in Older Women

Recent survey evidence indicates a decline in mammography use among older women. The objective of this study was to detect sensitivity of self-reported mammography use and pose evidence-based suggestions to increase survey accuracy. Using the 1991-2006 Medicare Current Beneficiary Survey, 15,357 women, aged > or =65 years, were selected based on use of mammography services. The women were interviewed in the community setting at random periods after screening and asked, Have you had a mammogram or breast X-ray since [today's date or previous supplement round interview date] a year ago? Statistical analyses were conducted between March 11 and April 28 of 2008. This study tested whether sensitivity (i.e., probability of an affirmative response) was dependent on length of the recall period and on respondent demographic and socioeconomic characteristics. Overall, 90.4% of the older women self-reported use; however, sensitivity decreased as the recall period lengthened (90% at 6 months, 80% at 12 months). This time effect was significantly higher among older, economically disadvantaged women. Sensitivity also decreased an additional 13.8% if the event occurred in the previous calendar year, and 3.5% if conducted in a non-English language or by proxy. Greatest sensitivity occurred during the 6-month period after service without straddling calendar years. These findings may aid the tailoring of future surveys for older adults, improving the recall of preventive services.

Mammography Use among Black Women: The Role of Electronic Medical Records

Accurately documenting mammography use is essential to assess quality of care for early breast cancer detection in underserved populations. Self-reports and medical record reports frequently result in different accounts of whether a mammogram was performed. We hypothesize that electronic medical records (EMRs) provide more accurate documentation of mammography use than paper records, as evidenced by the level of agreement between women's self-reported mammography use and mammography use documented in medical records. Black women aged 40-75 were surveyed in six primary care sites in Boston, Massachusetts (n = 411). Survey data assessed self-reported mammography prevalence within 2 years of study entry. Corresponding medical record data were collected at each site. Positive predictive value (PPV) of self-report and kappa statistics compared data agreement among sites with and without EMRs. Logistic regression estimated effects of site and patient characteristics on agreement between data sources. Medical records estimated a lower prevalence of mammography use (58%) than self-report (76%). However, self-report and medical record estimates were more similar in sites with EMRs. PPV of self-report was 88% in sites with continuous access to EMRs and 61% at sites without EMRs. Kappa statistics indicated greater data agreement at sites with EMRs (0.72, 95% CI 0.56-0.88) than without EMRs (0.46, 95% CI 0.29-0.64). Adjusted for covariates, odds of data agreement were greatest in sites where EMRs were available during the entire study period (OR 4.31, 95% CI 1.67-11.13). Primary care sites with EMRs better document mammography use than those with paper records. Patient self-report of mammography screening is more accurate at sites with EMRs. Broader access to EMRs should be implemented to improve quality of documenting mammography use. At a minimum, quality improvement efforts should confirm the accuracy of paper records with supplemental data.

Mammography Use from 2000 to 2006: State-Level Trends with Corresponding Breast Cancer Incidence Rates

Although breast cancer incidence and mortality rates have declined, a significant number of women are affected by this disease each year. Mammography is currently the most effective way to detect breast cancer at an early stage when it is most treatable, but there have been reports of decreasing or stagnant mammography use in the United States. For this study, we investigated the trend in mammography use for each state in comparison with the corresponding breast cancer incidence trend. We used data from the Behavioral Risk Factor Surveillance System for 2000, 2002, 2004, and 2006 to assess the percentage of women >or= 40 years old who reported undergoing mammography within the past 2 years and data from the National Program of Cancer Registries and the Surveillance, Epidemiology, and End Results Program to assess breast cancer incidence rates from 2000 through 2004, the latest year for which data were available at the time of the study. The majority of states had a decreasing tendency in mammography use from 2000 to 2006. Only one state had a statistically significant increase in reported mammography use, whereas two states had significant decreases. There was a correlation between breast cancer incidence rates and mammography use by states (r = 0.6), but no correlation between the time trends in breast cancer incidence rates and mammography use was observed. There was little statistically significant change in self-reported mammography use from 2000 to 2006. Continued monitoring of breast cancer screening practices and breast cancer incidence trends is important for targeting at-risk populations with effective interventions to improve breast cancer prevention and early detection.

Mammography Use Among Older Mexican-American Women: Correcting for Over-Reports of Breast Cancer Screening

ABSTRACT Objectives: To determine the accuracy of self-reported mammography use and generate a correction factor that adjusts for reporting errors among Mexican-American women. Design: Self-reported mammography use was compared with a medical chart review. Participants: A random sample of 199 Mexican-American women aged 50–74 in southeast Texas. Main Outcome Measures: Self-reported mammography use for the preceding 2 years and mammography use determined by medical chart review. Results: Positive and negative predictive values of mammography self-reports in the previous 2 years were 73.9 and 86.0%, respectively. The correction factor was 79.6%, or ∼80% of the self-reported mammograms within the preceding 2 years could be verified through medical chart reviews. Conclusions: Mammography use rates among Mexican-American women were not as high as self-reports indicated. Estimates need to be adjusted downward by approximately 20%.

Are Women With Self-Reported Cognitive Limitations at Risk for Underutilization of Mammography?

Functional limitations (namely, limitations in activities of daily living and instrumental activities of daily living) have previously been demonstrated to exert a negative influence on mammography utilization. This study examines self-reported cognitive limitation in addition to sociodemographic, functional, and other health-related factors to determine their relationship with self-reported mammography use in the previous year. Data from the 1998 National Health Interview Survey was analyzed for 6,053 women, ages 50 years and older. Just over 44% of women with self-reported cognitive impairment (n = 351) reported a mammogram in the previous year, compared with 55% of unimpaired women (n = 5,702). Logistic regression analysis indicates that the presence of a cognitive limitation significantly reduced the likelihood of a mammography in the previous year (p < 0.05) after controlling for other sociodemographic, functional, and health-related factors. Women with self-reported cognitive limitations were 30% less likely than unimpaired women to utilize mammography after controlling for various forms of disability and other factors. Thus, women with cognitive impairments may be at risk for underutilization of mammography and therefore at risk for later-stage breast cancer diagnoses.

The role of trust in use of preventive services among low-income African-American women

Background. This study explored factors that predict higher trust in primary care providers, and examined the role of patient trust on the use of preventive services for low-income African-American women. Methods. We conducted a cross-sectional, population-based telephone survey of 961 African-American women over age 40 in Washington, DC. Two dimensions of trust were examined: overall trust in one's regular primary care provider, and trust that the regular provider had no financial conflict of interest. Self-reported use of mammography, Pap tests, clinical breast exams, colorectal cancer screening, blood pressure, height and weight measurement, diet counseling, and depression screening, as delivered by one's primary care provider, were assessed. An index summarizing overall use of these interventions was the main outcome variable. Results. More than two-thirds of respondents reported high trust in their physician. Older respondents (>65) were more trusting of their physicians overall than were younger respondents ( P < 0.01). Primary care characteristics (continuity of care, accessibility of the practice, coordination of specialty care by one's regular provider) were more strongly associated with having high trust than were sociodemographic, health status, and insurance characteristics. Higher trust was significantly associated with greater use of recommended preventive services (OR: 2.3, 95% CI: 1.3, 4.0), controlling for the effects of insurance status, primary care, and patient characteristics. Conclusions. Trust is associated with use of recommended preventive services in low-income African-American women. Stronger patient–provider relationships, with high levels of trust, may indirectly lead to better health through adherence to recommended preventive services for low income African-American women.

Racial/ethnic differences in the self-reported use of screening mammography.

The efficacy of mammography in reducing breast cancer mortality among women 50-69 years of age has been demonstrated in randomized controlled studies, but many women, especially ethnic minorities, have not been receiving regular mammographic screening. The current study investigated racial/ethnic differences in mammography use and their association with demographic characteristics and other factors. The study population consisted of 4,444 women aged 40 years and older who participated in the 1996 Medical Expenditure Panel Survey. Outcome measures studied included the self-reporting of mammography within the past two years and past year. Multivariate logistic regression modeling was used to examine the effect of race while controlling for other factors. In the univariate analysis, there was virtually no difference between white, black, and Hispanic women in mammography rates within either one or two years. However, multivariate logistic regression suggested that both blacks and Hispanics were more likely than whites to have received recent mammography, as black women were 31% and Hispanic women were 43% more likely than white women to have had a mammogram within the previous two years. Our results suggest that white women are no longer more likely to receive periodic screening mammography than black and Hispanic women, and in fact, might even be less likely to undergo the procedure. This reversal might indicate, at least in part, that programs and other activities to promote screening mammography among ethnic minority women have been successful and should now be expanded to include other women.

Subgroup-specific effects of questionnaire wording on population-based estimates of mammography prevalence

This study investigated whether an apparent downturn in prevalence rates of mammography use reported in the 1992 Behavioral Risk Factor Surveillance System (BRFSS) questionnaire resulted from a change in questionnaire wording. In a pretest-posttest design (1990-1991 vs 1992), piecewise linear regression analyses were based on monthly prevalence estimates of mammography use among female BRFSS respondents 40 years or older. Self-reported mammography use was lower by 3.5 percentage points (95% confidence interval [CI] = 1.5, 5.5) overall--and lower by 13.6 percentage points (95% CI = 2.6, 24.6) among Black women with less than a high school education--when predicted from 1992 data than when predicted from 1990-1991 data. A change in questionnaire wording in the BRFSS caused demographic-specific effects in population-based estimates of mammography use.