Utilization Of Mammography Screening Research Articles

Determinants of breast cancer screening mammography uptake: Results from Jordan population and family health survey.

Screening for breast cancer utilizing mammography is associated with reduced advanced cancer diagnosis and reduced breast cancer mortality. We aimed to assess the lifetime history of breast cancer screening utilization for Jordanian women aged 40 and 49 years and determinants of this utilization. This paper reports the analyzed data from the seventh cycle of the Jordan Population and Family Health Survey (JPFHS). For this study, the analysis was confined to 4486 women aged between 40 and 49 years at the time of data collection who reported their nationality as Jordanian. We used multivariate logistic regression analysis to assess whether any socio-demographic variables could predict greater breast cancer screening utilization. Only 14% of all respondents aged 40-49 years reported ever having a mammogram. Results of multivariate logistic regression showed that area of residence, husband's level of education, younger age, and living in a wealthy status were strong predictors of lifetime history of breast cancer screening. This study elucidates that breast cancer screening mammography among Jordanian women has remained opportunistic and underutilized despite the efforts of national entities to promote screening and early detection of breast cancer. There is a geographic and social disparity in the utilization of mammography screening among Jordanian women.

The Impact of IT-Based Healthcare Communication on Mammography Screening Utilization among Women in the United States: National Health Interview Survey (2011-2018).

Effective patient–provider communication improves mammography utilization. Using information technology (IT) promotes health outcomes. However, there are disparities in access to IT that could contribute to disparities in mammography utilization. This study aims to assess the association between IT-based health care communication and mammography utilization and to evaluate if this effect is modified by race/ethnicity and age. To this end, this study was conducted using the National Health Interview Survey from 2011 to 2018. A total of 94,290 women aged 40 years and older were included. Multiple logistic regression models were used, and odds ratios were reported. The study found that all IT-based healthcare communication strategies were significantly associated with mammography utilization in all years from 2011 to 2018. In 2018, women who looked up health information on the internet, scheduled a medical appointment on the internet, and communicated with providers by email had a significantly higher chance to use mammography (p ≤ 0.005 for all strategies across all years). White women and women aged 50 years and older benefited the most from IT-based healthcare communication. In conclusion, facilitating access to IT may help increase mammography utilization, which may contribute to eliminating disparities in breast cancer mortality.

Practice, Perceptions, and Prospects of Mammography Screening in Nigeria: Insights From a National Survey of Female Health Workers

BackgroundMammography, the most preferred tool for breast cancer screening, has very poor uptake in Nigeria, even among health workers. No nationwide study has been done to ascertain this. This study sought to determine the current perceptions and practices of Nigerian female health care practitioners on mammography screening across different types and levels of health care institutions in the country's 6 geopolitical zones. MethodsThis cross-sectional online survey was conducted using Google Forms distributed among Nigerian female health workers via online professional associations and networks. Descriptive and inferential statistics were done using SPSS version 20. ResultsA total of 562 respondents, with mean age of 41.30 ± 9.8 years, were surveyed. About half (50.3%) were doctors, with majority practicing in southern Nigeria. A mammography screening utilization rate of 15.4% was found, with majority having their first mammography long after attaining the age of eligibility. As of the time of the survey, only 24.8% of tertiary health workers had access to functional mammography machines at their place of work. Majority of female doctors (78%) never refer eligible patients for mammography, although nearly all (98.6%) were willing to do so. About 54% of those who have had a previous mammography screening vs. 17% who have not had 1 would recommend it to others. Majority of respondents recommended annual mammography from the age of forty at a subsidized cost. ConclusionNigerian female health workers have limited access to mammography and consequently do not screen often. Efforts must be made to make ‘charity begin at home’.

Identifying key barriers to effective breast cancer control in rural settings

Breast cancer is the most common cancer and the second most common cause of cancer mortality among women in the United States. Efforts to promote breast cancer control in rural settings face specific challenges. Access to breast cancer screening, diagnosis, and treatment services is impaired by shortages of primary care and specialist providers, and geographic distance from medical facilities. Women in rural areas have comparable breast cancer mortality rates compared to women in urban settings, but this is due in large part to lower incidence rates and masks a substantial rural/urban disparity in breast cancer survival among women diagnosed with breast cancer. Mammography screening utilization rates are slightly lower among rural women than their urban counterparts, with a corresponding increase in late stage breast cancer. Differences in breast cancer survival persist after controlling for stage at diagnosis, largely due to disparities in access to treatment. Travel distance to treatment centers is the most substantial barrier to improved breast cancer outcomes in rural areas. While numerous interventions have been demonstrated in controlled studies to be effective in promoting treatment access and adherence, widespread dissemination in public health and clinical practice remains lacking. Efforts to improve breast cancer control in rural areas should focus on implementation strategies for improving access to breast cancer treatments.

Impact of disruptions in breast cancer control due to the COVID-19 pandemic on breast cancer mortality in the United States: Estimates from collaborative simulation modeling.

6562 Background: The COVID-19 pandemic has disrupted breast cancer control through short-term declines in screening, delays in diagnosis and reduced/delayed treatments. We projected the impact of COVID-19 on future breast cancer mortality.Methods: Three established Cancer Intervention and Surveillance Modeling Network (CISNET) models projected the impact of pandemic-related care disruptions on breast cancer mortality between 2020 and 2030 vs. pre-pandemic care patterns. Based on Breast Cancer Surveillance Consortium data, we modeled reductions in mammography screening utilization, delays in symptomatic cancer diagnosis, and reduced use of chemotherapy for women with early-stage disease for the first six months of the pandemic with return to pre-pandemic patterns after that time. Sensitivity analyses were performed to determine the effect of key model parameters, including the duration of the pandemic impact. Results: By 2030, the models project 1,297 (model range: 1,054-1,900) cumulative excess deaths related to reduced screening; 1,325 (range: 266-2,628) deaths from delayed diagnosis of symptomatic women, and 207 (range: 146-301) deaths from reduced chemotherapy use for early-stage cancer. Overall, the models predict 2,487 (range 1,713-4,875) excess deaths, representing a 0.56% (range: 0.36%-0.99%) cumulative increase over deaths that would be expected by 2030 in the absence of the pandemic’s disruptions. Sensitivity analyses indicated that the impact on mortality would approximately double if the disruptions lasted for a 12-month period. Conclusions: The impact of the initial pandemic-related disruptions in breast cancer care will have a small long-term cumulative impact on breast cancer mortality. The impact of the initial pandemic-related disruptions on breast cancer mortality will largely be mitigated by the rapid return to usual care. As the pandemic continues it will be important to monitor trends in care and reassess the mortality impact.[Table: see text]

Divergent Patterns and Trends in Breast Cancer Incidence, Mortality and Survival Among Older Women in Germany and the United States.

Background: Breast cancer treatment has changed tremendously over the last decades. In addition, the use of mammography screening for early detection has increased strongly. To evaluate the impact of these developments, long-term trends in incidence, mortality, stage distribution and survival were investigated for Germany and the United States (US). Methods: Using population-based cancer registry data, long-term incidence and mortality trends (1975–2015), shifts in stage distributions (1998–2015), and trends in five-year relative survival (1979–2015) were estimated. Additionally, trends in five-year relative survival after standardization for stage were explored (2004–2015). Results: Age-standardized breast cancer incidence rates were much higher in the US than in Germany in all periods, whereas age-standardized mortality began to lower in the US from the 1990s on. The largest and increasing differences were observed for patients aged 70+ years with a 19% lower incidence but 45% higher mortality in Germany in 2015. For this age group, large differences in stage distributions were observed, with 29% (Germany) compared to 15% (US) stage III and IV patients. Age-standardized five-year relative survival increased strongly between 1979–1983 and 2013–2015 in Germany (+17% units) and the US (+19% units) but was 9% units lower in German patients aged 70+ years in 2013–2015. This difference was entirely explained by differences in stage distributions. Conclusions: Overall, our results are in line with a later uptake and less extensive utilization of mammography screening in Germany. Further studies and efforts are highly needed to further explore and overcome the increased breast cancer mortality among elderly women in Germany.

Factors Affecting Mammography Screening Utilization among Educated Women in Al Beheira Governorate, Egypt.

Background:Breast cancer (BC) is the leading cancer in women worldwide and is increasing particularly in developing countries where the majority of cases are diagnosed in late stages. Early detection at an early stage by mammography screening leads to better prognosis and improves the survival rate for this malignancy. The aim of the study was to analyze factors that affect mammography screening utilization among educated women.Patients and Methods:A total of 700 educated women aged 40 years and older were included in a community-based cross-sectional interview survey that was conducted in between June 2017 and August 2018 in Al Beheira governorate Egypt.Results:Multivariate logistic regression revealed that lack of knowledge about mammography (odds ratio [OR] = 9.8), education level (OR = 6.0), employment status (OR = 3.5), cancer fatalism (OR = 3.0), residence (OR = 2.8), fear of embarrassment (OR = 2.6, fear of positive result (OR = 2.4), family income (OR = 1.9), and health insurance (OR = 1.8) were significant (P < 0.05) predictors of mammography screening utilization.Conclusion:Mammography utilization screening rate is low. Lack of knowledge about mammography, cultural norms, and socioeconomic factors were barriers to mammography screening.

Mammography Screening Utilization Behavior among Egyptian Female Employees in Alexandria

Mammography Screening Utilization Behavior among Egyptian Female Employees in Alexandria

Assessing the Key Attributes of Low Utilization of Mammography Screening and Breast-self Exam among African-American Women.

PURPOSE: African-American (AA) women living in four Black Belt Counties (BBC) of Alabama; consisting of Barbour, Macon, Green and Wilcox are known to have lower mammogram utilization and breast self-exam rates when compared to their white female counterparts. The influence of socioeconomic and demographic factors on these disparities has not been clearly defined so far. Our study was designed to determine whether these observed disparities can be predicted with the socioeconomic and other demographic attributes. METHODS: Health Disparity Questionnaires data (n = 516) for BBC of Alabama was analyzed using a logistic regression model to examine the association of breast cancer screening rates and breast self-exam with income, the level of education, family doctor, type of health insurance, obesity, and age. RESULTS: Income, education, family doctor, age and health insurance were independent predictors for the low utilization rate of mammography and breast self-exam (BSE). CONCLUSION: Improving socioeconomic conditions such as level of education and availability of health care are essential to increase the rates of breast cancer screening test and breast self-exam in the BBC of Alabama.

Health Care Access and Breast Cancer Screening Among Latinas Along the California–Mexican Border

Latinas are more likely to exhibit late stage breast cancers at the time of diagnosis and have lower survival rates compared to white women. A contributing factor may be that Latinas have lower rates of mammography screening. This study was guided by the Behavioral Model of Health Services Use to examine factors associated with mammography screening utilization among middle-aged Latinas. An academic-community health center partnership collected data from community-based sample of 208 Latinas 40 years and older in the San Diego County who completed measures assessing psychosocial factors, health care access, and recent mammography screening. Results showed that 84.6 % had ever had a mammogram and 76.2 % of women had received a mammogram in the past 2 years. Characteristics associated with mammography screening adherence included a lower acculturation (OR 3.663) a recent physician visit in the past year (OR 6.304), and a greater confidence in filling out medical forms (OR 1.743), adjusting for covariates. Results demonstrate that an annual physical examination was the strongest predictor of recent breast cancer screening. Findings suggest that in this community, improving access to care among English-speaking Latinas and addressing health literacy issues are essential for promoting breast cancer screening utilization.

National survey of breast cancer screening in rural America.

13 Background: Screening mammography leads to early detection of breast cancer and improved survival. We conducted a survey of predominantly rural U.S. women who receive health insurance through the National Rural Electric Cooperative Association (NRECA) to evaluate the prevalence of annual and biennial screening and to identify potential disparities and barriers to breast cancer screening. Methods: We conducted a national cross-sectional survey of women between ages 40 and 65 who are insured by the NRECA regarding their utilization of mammography screening and barriers to screening. A study specific survey was mailed to 2,000 randomly selected eligible women without prior diagnosis of breast cancer. We assessed demographics and receipt of mammography within past 12 months (all women) and number of screening mammograms within the past 4 years (among women age 44 and older) to identify consistent annual screening and biennial screening patterns. Results: 1,204 women responded to the survey (response rate 60.2%). 74% live in rural areas, 18% suburban, 8% urban. 73% report less than 4 years college education and 19% have family incomes &lt; $50,000/year. Overall, 72% reported screening mammography within 12 months, 59% reported consistent annual screening and 84% reported at least biennial screening. Rural women were less likely to undergo consistent annual (56% vs. 66%, p = 0.003) or biennial screening (82% vs. 89%, p = 0.01) compared to women in non-rural areas. Women under 50 were less likely to report screening within 12 months (67% vs. 77%, p = 0.0002), consistent annual (49% vs. 63%, p &lt; 0.0001) or biennial screening (79% vs. 86%, p = 0.002). Significantly more rural women cited cost and distance as barriers, while busy schedule, fear of diagnosis, and fear of discomfort were important barriers among all demographic groups. Fear of the test was a greater barrier among younger vs. older women (p &lt; 0.02). In univariate analysis; household income did not correlate with screening, and education was only a factor among younger women. Conclusions: A substantial percentage of rural U.S. women fail to undergo screening mammography. Potentially modifiable barriers include out of pocket expenses, convenience of screening, and fear of diagnosis and the test itself.

Breast Cancer Overdiagnosis With Screening Mammography

Zahl et al’s study in four Norwegian counties suggests that some of the occult invasive breast cancers detected by mammography screening might ultimately have undergone spontaneous regression (1). Population-based statistics in the United States support this hypothesis as well (2). Indeed, since the advent of mammography screening, age-specific breast cancer incidence rates in Europe have increased dramatically among women in those age groups targeted for screening (3). For example, in many western European countries, systematic screening programs were introduced in the late 1980s and early 1990s for women aged 50–69, and this was followed by sharp increases in the incidence of invasive breast cancer in these women (3). This trend is also observed in the United States, as illustrated in figure 1, using data from the Connecticut Historical database of the National Cancer Institute’s Surveillance, Epidemiology, End Results (SEER, http://seer.cancer.gov/) program. This figure shows that, since the late 1970s, with increasing utilization of mammography screening among women aged 40–80, age-specific incidence rates for this age group have increased from their baseline rate during 1966 to 1975. Figure 1 Although mammography screening might be expected to transiently increase the incidence of invasive breast cancer, assuming constant risks, it should also ultimately result in a corresponding decrease in invasive cancer incidence among the elderly. Yet the Connecticut data indicate that, in the elderly population, incidence rates for invasive breast cancers during the latest time period (490 per 100,000 woman-years in 1996–2005) has not dropped below the baseline rate prior to the advent of mammography screening (363 per 100,000 woman-years in 1966–2005), figure 1. Similar incidence patterns have also been observed in Europe (3). Taken together, these incidence patterns might be interpreted to mean that mammography screening results in a significant diagnosis of occult, non-lethal invasive breast cancers. Furthermore, the improved prognosis of screen-detected cancers, as described by Shen et al. and Joensuu et al, might partly be attributable to the effects of this over-diagnosis (4, 5). It has long been accepted that mammography screening results in a significant over-diagnosis of ductal carcinoma in situ (DCIS) (6). We must now accept the possibility that screening may result in the over-diagnosis of occult, non-lethal invasive breast cancers as well. Newer screening technology (such as digital mammography and magnetic resonance imaging) may further increase the detection rate of these occult, non-lethal invasive cancers.

Higher Incidence of Aggressive Breast Cancers in African-American Women: A Review

Despite a lower incidence of breast cancers in African Americans than in Caucasians, mortality rates from breast cancer are higher in African Americans. This review summarizes disparate characteristics of breast cancer diagnosed in African Americans as compared with Caucasians, such as more advanced stage at diagnosis and less estrogen-receptor positivity of disease, in an effort to explain differences in their survival outcomes. Multifactorial explanations are offered, including differences in access to care, disparate utilization of mammography screening and often differences in treatment course-as well as biologic factors, such as higher incidence of aggressive breast cancer phenotypes, higher grade of tumor and higher growth index of tumors in African Americans as compared with Caucasians. Multiple population-based studies have been reviewed and screening and treatment interventions proposed in order to heighten awareness of these differences and to improve disease outcomes among this high-risk population.

Factors Influencing Mammography Screening of Chinese American Women

To explore factors influencing breast cancer screening behavior among Chinese women residing in the United States. A descriptive study guided by the health belief model adapted for Chinese American women. An English-language questionnaire was modified, translated, and pretested before use in the study sample. Data were analyzed using descriptive and multivariate analysis techniques. An urban area in Michigan in 2001. A consecutive nonprobability sample of 206 Chinese American women age 40 and older. The percentage of women age 40 and older who received a mammogram in the past year. Access to health care, perceived barriers to mammography screening, need for breast health care, and information-seeking behavior had direct effects on Chinese American women's mammography screening utilization. Cultural affiliation had an indirect effect on breast cancer screening behavior, moderated through access to health care. The variance in mammography screening explained by these factors was 51%. Effective strategies for promoting breast cancer screening among Chinese American women should address ways to improve information-seeking behaviors and access to health care. Cultural affiliation and beliefs should be considered when counseling Chinese American women regarding breast cancer screening.

The Dual Enrolled as a Disadvantaged Population: Developing Culturally Informed Interventions for Tennessee Medicare/Medicaid Women

The Centers for Medicare and Medicaid Services (CMS) have begun a major national initiative to reduce disparities in health care for the underserved through their contracts with state quality improvement organizations (QIOs). This initiative has translated into state-level projects that are, in many cases, investigating these populations to determine how best to address their health care deficiencies and improve the quality of their care. Tennessee's campaign, coordinated by the Center for Healthcare Quality (CHQ), the state's QIO, focused on the use of formative research to gain insights into diversity among the underserved in different settings across the state. Results aided the design of a series of site-appropriate interventions aimed at improving the utilization of mammography screening among Tennessee's Dual Enrolled: Medicare beneficiaries who are also enrolled in Medicare.

Mammography screening in African American women: evaluating the research.

Notwithstanding some controversy regarding the benefits of screening mammography, it is generally assumed that the effects are the same for women of all race/ethnic groups. Yet evidence for its efficacy from clinical trial studies comes primarily from the study of white women. It is likely that mammography is equally efficacious in white and African American women when applied under relatively optimal clinical trial conditions, but in actual practice African Americans may not be receiving equal benefit, as reflected in their later stage at diagnosis and greater mortality. Initial searches of Medline using search terms related to screening mammography, race, and other selected topics were supplemented with national data that are routinely published for cancer surveillance. Factors that potentially compromise the benefits of mammography as it is delivered in the current health care system to African American women were examined. While there have been significant improvements in mammography screening utilization, observational data suggest that African American women may still not be receiving the full benefit. Potential explanatory factors include low use of repeat screening, inadequate followup for abnormal exams, higher prevalence of obesity and, possibly, breast density, and other biologic factors that contribute to younger age at diagnosis. Further study of biologic factors that may contribute to limited mammography efficacy and poorer breast cancer outcomes in African American women is needed. In addition, strategies to increase repeat mammography screening and to ensure that women obtain needed followup of abnormal mammograms may increase early detection and improve survival among African Americans. Notwithstanding earlier age at diagnosis for African American women, mammography screening before age 40 years is not recommended, but screening of women aged 40-49 years is particularly critical.