Perspectives in Disease Prevention and Health Promotion State-to-S tate Variation in Screening Mammograms for Women 50 Years of Age and Older -- Behavioral Risk Factor Surveillance System, 1987

The National Cancer Institute and the American Cancer Society (ACS) recommend that women greater than or equal to50 years old have an annual screening mammogram and that women aged 40-49 years have a mammogram every 1-2 years (1,2). Based on data from the 1987 Behavioral Risk Factor Surveillance System (BRFSS), the percentages of women greater than or equal to50 years old who had had a screening mammogram in the preceding 12 months were estimated by state for the 33 participating states.

During 1987, all women who were interviewed for the BRFSS were asked a series of questions about mammograms. The percentage of women who reported having had a screening mammogram increased substantially during 1987 (3). To assess whether all states participated equally in the movement toward increased use of screening mammograms, the quarterly trend in the percentage of women screened during 1987 was determined by state of residence.

In the BRFSS, each participating health department administers monthly random digit-dialed telephone interviews to persons greater than or equal to18 years old (4). Questionnaires are standardized to allow comparisons of results among states. Of the contacts made with eligible respondents, the median response rate for the 33 participating states was 83%.

The questions about mammography addressed knowledge of, experience with, and reasons for mammography. Since mammograms administered because of a breast problem or a personal history of breast cancer were not considered screening mammograms, women who had mammograms for these reasons were excluded from this analysis.

Each woman was also asked about visits to a physician for routine preventive care. Because most mammograms are done in the context of routine preventive care provided by a physician, the results presented are limited to women who had seen a physician for a routine examination during the year preceding the interview. The data were weighted to account for the age and race distribution of women residing in each state and for the respondents' probability of selection. Therefore, the results are representative of the total population of women greater than or equal to50 years old who reside in the 33 states surveyed.

Estimates of the percentages of women screened varied threefold, from 15% in Indiana to 46% in New Hampshire (median 30%). The 33 states were divided into terciles based on the percentage of women who reported having had a screening mammogram in the last year (Table 1).

When estimates of the percentages of women screened were examined by quarter of interview and tercile of the interviewee's state of residence, states in the third (lowest) tercile had the smallest absolute and relative increase in the percentage of women screened, whereas states in the first and second terciles of screening prevalences had greater increases in the percentages of women who reported being screened (Figure 1, Table 2). Thus, in 1987, the states in the third tercile appeared to be falling behind the states in the first and second terciles. Reported by: The following state BRFSS coordinators: R Strickland, Alabama; T Hughes, Arizona; L Parker, California; M Rivo, District of Columbia; S Hoecherl, Florida; JD Smith, Georgia; E Tash, Hawaii; J Mitten, Idaho; B Steiner, Illinois; S Joseph, Indiana; K Bramblett, Kentucky; R Schwartz, Maine; A Weinstein, Maryland; L Koumijian Yandel, Massachusetts; N Salem, Minnesota; N Hudson, Missouri; R Moon, Montana; R Thurber, Nebraska; K Zaso, New Hampshire; L Pendley, New Mexico; H Bzduch, New York; C Washington, North Carolina; B Lee, North Dakota; E Capwell, Ohio; J Cataldo, Rhode Island; D Lackland, South Carolina; L Post, South Dakota; D Riding, Tennessee; J Fellows, Texas; C Chakley, Utah; K Tollestrup, Washington; R Anderson, West Virginia; R Miller, Wisconsin. Office of Surveillance and Analysis, Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: Explanations for the wide state-to-state variation in the percentage of women greater than or equal to50 years old who reported having had a screening mammogram in the last year may reflect several factors, including differences in physician practices concerning preventive care, the proportions of women who have insurance coverage for screening mammograms, the socioeconomic status of the populations of the states surveyed, the impact of media events during 1987 (3), and state programs' efforts to increase public awareness about screening for breast cancer and use of specific campaigns to promote mammography. For example, in 1987, the Rhode Island Department of Health implemented a broad-based effort to promote the use of screening mammograms (5). In the District of Columbia, with funding from ACS and the cooperation of the Commission of Public Health and several local hospitals, a free cancer screening and mammogram campaign was conducted during 1986. Subsequently, six hospitals and radiology centers now offer screening mammograms for less than or equal to$50.00; two offer screening for only $25.00 (6).

The increases in the percentages of women screened during 1987 are encouraging. Based on the quarterly trends, however, states in the lowest tercile also had the smallest increases in screening activity. Continued use of the BRFSS to monitor these trends may help identify programs of state health agencies that successfully promote the use of screening mammograms, and knowledge about their programs can then be used to promote screening mammograms on a broader scale.

References

1. National Cancer Institute. Working guidelines for early cancer detection: rationale and supporting evidence to decrease mortality. Washington, DC: US Department of Health and Human Services, Public Health Service, 1987. 2.American Cancer Society. Mammography 1982: a statement of the American Cancer Society. CA 1982;32:226-30. 3.CDC. Trends in screening mammograms for women 50 years of age and older--Behavioral Risk Factor Surveillance System, 1987. MMWR 1989;38:137-40. 4.Remington PL, Smith MY, Williamson DF, Anda RF, Gentry EM, Hogelin GC. Design, characteristics, and usefulness of state-based Behavioral Risk Factor Surveillance: 1981-87. Public Health Rep 1988;103:366-75. 5.CDC. Use of mammography for breast cancer screening--Rhode Island, 1987. MMWR 1988; 37:357-60. 6.Commission of Public Health. Annual report of the District of Columbia Cancer Consortium, 1987. Washington, DC: Department of Human Services, Commission of Public Health.

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