Regular mammography screening combined with timely and appropriate treatment can reduce mortality from breast cancer by 30% in women ages 50 to 69 years and by 16% in women ages 40 to 49 years. A physicians recommendation has been strongly associated with a patient actually having a mammogram.
This report analyzes data collected during 1997 in North Carolina as part of the Behavioral Risk Factor Surveillance System (BRFSS). These data indicated that 23% of women ³ 40 years old who had had a routine physical examination during the 2 years preceding the survey did not recall having a discussion about mammography with a health care provider.
The BRFSS is an annual, state-based, standardized, random-digitdialed telephone survey of noninstitutionalized US adults age 18 years and over. The overall survey response rate in 1997 was 78%.
During that survey, women aged 40 years or older were asked Has a doctor or other health professional ever talked with you about having a mammogram as part of your routine health care? Women who responded yes were then asked how many years ago the discussion had occurred. The sample was restricted to the 1,209 (92%) subjects who reported having had a routine physical examination during the previous 2 years. Responses were weighted to reflect the age, race, and sex distribution of adults in North Carolina, and the probability of selection; 95% confidence intervals were calculated using Survey Data Analysis (SAS) software.
In this sample of women age ³ 40 years who reported having had a routine examination during the previous 2 years, 77% reported that a health care provider had discussed mammography with them (Table 1). This percentage was highest among women ages 50 to 59 years (86%) and 60 to 69 years (86%), and declined to 54% among women ages 80 years or more.
Reported mammography discussion increased with education, from 63% among women with a grade school education or less to 82% among women with at least some college. Of women with an annual household income of less than $15,000, 65% reported having a discussion about mammography, compared with 80% to 82% of those in higher income groups. Women with health care coverage were also more likely than those without to report a discussion on mammography, but this difference was not significant because of the small number of women without coverage. No significant difference by race was observed.
Editorial Note from the CDC
Despite strong evidence that regular mammography screening reduces breast cancer mortality, one-fourth of women ³ 40 years old who received a routine physical examination in the 2 years before the survey did not recall a health care provider discussing mammography with them. The percentage varied by age and might reflect the conflicting recommendations regarding mammography screening for women ages 40 to 49 years and the unknown benefit of screening women 70 years or older. The lower percentage among older women also might reflect the fact that older women are less likely to receive a routine physical examination from an obstetrician/gynecologist, the specialist most likely to recommend mammography screening.
The 1997 North Carolina BRFSS data indicated that black women were as likely as white women to report a discussion with their health care provider about mammography. Other data indicated that black women were also as likely as white women to have had a mammogram during the previous 2 yearsa finding consistent with the 1994 National Health Interview Survey.
The BRFSS data also indicated that reported mammography was lower for women without health care coverage, with less education, and with annual household incomes of less than $15,000findings suggesting that presumed financial barriers may make providers less likely to discuss screening. Providers need to be aware of changes in Medicare and Medicaid mammography screening schedules and the availability of inexpensive and no-cost screening through the National Breast and Cervical Cancer Early Detection Program. Because the percentage of women who have had a routine physical examination during the previous 2 years declines with income, education, and health-care coverage in the BRFSS sample, women with these characteristics are even less likely to learn of the importance of regular screening.
The findings in this report are subject to at least three limitations. First, these data are based on respondent recall and may not accurately reflect the actual discussions. Also, the respondent was asked only whether a discussion had occurred and not whether a recommendation was made. Second, the survey was conducted by telephone, excluding approximately 5% of North Carolina households with no telephone. Third, the sample size in some subgroups was small, making it difficult to control for confounding factors in the analysis.
Importance of Provider Recommendation
The importance of provider recommendation is evident from other data in the survey. For example, 86% of women who reported a provider discussion of mammography during the previous 2 years also reported having had a mammogram during the previous 2 years vs 44% of women who did not report such a discussion.
Also, one-third of women who did not have a recent mammogram cited lack of provider recommendation as the main reason that they had not been screened. Health care providers in North Carolina should recommend mammography screening for all women ³ 40 years old.