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Self-Reported Use of Mammography Among Women Aged greater than or equal to 40 Years -- United States, 1989 and 1995

In 1997, breast cancer will be diagnosed in an estimated 180,200 women, and 43,900 women will die from the disease (1). Early detection combined with timely and appropriate treatment can alter the progress of and reduce mortality from this disease (2). Effective screening procedures are available to detect breast cancer in its early stages. However, the benefits of breast cancer screening to reduce mortality in the population can be achieved only if screening guidelines are followed and a large proportion of women receive screening examinations regularly. To estimate the state-specific proportions of women aged greater than or equal to 40 years who reported receiving a mammogram during the preceding 2 years, CDC analyzed data from the Behavioral Risk Factor Surveillance System (BRFSS) for 1989 and 1995. This report presents the findings, which indicate that, from 1989 to 1995, the percentage of women aged greater than or equal to 40 years who reported receiving a mammogram during the preceding 2 years increased in all 39 states in the survey.

In 1989 and in 1995, a total of 39 states * participated in BRFSS. Using a multistage sampling design and a random-digit-dialed telephone survey, each state conducted monthly telephone interviews of a random sample of its noninstitutionalized adult (aged greater than or equal to 18 years) population to provide state-specific estimates of risk factors and the use of preventive services (3). Annual data are weighted to the age, sex, and race distribution of each state's adult population using the most current census or inter-censal estimates. Three BRFSS questions focused on mammography use and were asked only of female respondents aged greater than or equal to 40 years. Each respondent was asked, "Have you ever had a mammogram?" If the respondent answered "yes" to that question, she was asked, "How long has it been since your last mammogram?" and "Was it part of a routine checkup, because of a breast problem other than cancer, or because you had already had breast cancer?" In this analysis, estimates are age-adjusted to the age distribution of women in the 1989 BRFSS sample for participating states.

From 1989 to 1995, the overall age-adjusted proportion of women aged greater than or equal to 40 years who reported having had a mammogram during the preceding 2 years increased in each of the 39 participating states (Table_1). The age-adjusted proportion varied widely among the states, from 43.8%-65.2% in 1989 to 63.0%-79.7% in 1995. The median age-adjusted proportion was 53.3% in 1989 and 69.5% in 1995. During this period, the state-specific relative percentage increase ranged from 9% in Minnesota (which, in 1989, already had a relatively high proportion of women who reported having had their most recent mammogram during the preceding 2 years) to approximately 45% in West Virginia and New York.

Reported by: Epidemiology and Statistics Br, Div of Cancer Prevention and Control; Health Care and Aging Br, Div of Adult and Community Health (proposed), National Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: Mammography is the primary procedure for breast cancer screening. The U.S. Preventive Services Task Force recommends a screening mammogram every 1-2 years for women aged 50-69 years (2). In addition, physicians can recommend that high-risk women aged less than 50 years receive a screening mammogram. The National Cancer Institute's 1997 mammography guidelines recommend screening mammograms every 1-2 years for women aged greater than or equal to 40 years if they are at average risk for breast cancer (4). Recently revised American Cancer Society guidelines recommend annual mammography for women aged greater than or equal to 40 years (5).

The findings in this report indicate that, from 1989 to 1995, the percentage of women aged greater than or equal to 40 years who reported having had a mammogram during the preceding 2 years increased in all 39 states participating in BRFSS. This finding is consistent with previous studies that indicated increasing reported use of screening mammograms. For example, based on data from the National Health Interview surveys, of women aged greater than or equal to 40 years in 1987, 29% reported having had a mammogram during the preceding 2 years; in 1994, the proportion increased to 61% (6). Similarly, the proportion of women who reported receiving breast cancer screening consistent with American Cancer Society guidelines increased from 31% in 1990 to 47% in 1995 (7).

The findings in this report are subject to at least four limitations. First, only 39 states participated in both the 1989 and 1995 BRFSSs; therefore, the results may not be generalizable to the total U.S. population of women aged greater than or equal to 40 years. Second, the telephone survey excluded women living in households without a telephone. Although only 5% of U.S. households are without telephones, the proportion of persons without telephones varies by geographic region, and the characteristics of households with and without telephones are different (8). Thus, the differences observed in this survey may not reflect trends for women without telephones. Third, self-reported mammography use may not be consistent with reports of mammography use from other sources such as medical and imaging-center records (9). Finally, because approximately 15%-20% of contacted households did not respond and respondents may be different from nonrespondents, the precision of the estimates in this report may be reduced.

Regular breast cancer screening can reduce the annual rate of breast cancer deaths in the United States; the estimated potential reduction ranges from 19% to 30% for women aged 50-74 years (2). Federal initiatives, such as CDC's National Breast and Cervical Cancer Early Detection Program (NBCCEDP) and Medicare, encourage breast cancer screening by paying for mammograms for women eligible to participate in these programs (10). Since 1991, Medicare has provided insurance coverage for bi-annual mammograms. NBCCEDP provides states, U.S. territories, and programs serving American Indians/Alaskan Natives with resources to provide screening, follow-up, and referral services to medically underserved women. NBCCEDP outreach efforts are aimed at older women, women with low incomes, uninsured or underinsured women, and women of racial/ethnic minority groups. Initiatives to encourage women to receive an initial screening for breast cancer are essential and should emphasize rescreening.

References

  1. American Cancer Society. Cancer facts and figures, 1997. Atlanta, Georgia: American Cancer Society, 1997.

  2. US Preventive Services Task Force. Screening for breast cancer. In: US Preventive Services Task Force. Guide to clinical preventive services. 2nd ed. Baltimore, Maryland: Williams & Wilkins, 1996:73-87.

  3. Frazier EL, Franks AI, Sanderson LM. Using Behavioral Risk Factor Surveillance data. In: CDC. Using chronic disease data: a handbook for public health practitioners. Atlanta, Georgia: US Department of Health and Human Services, Public Health Service, CDC, 1992:4-1-4-17.

  4. Eastman P. NCI adopts new mammography screening guidelines for women. J National Can-cer Instit 1997;89:538-9.

  5. Leitch AM, Dodd GD, Costanza M, et al. American Cancer Society guidelines for the early detection of breast cancer: update 1997. CA-A Cancer Journal for Clinicians 1997;47:150-3.

  6. National Center for Health Statistics. Health, United States, 1996-97 and injury chartbook. Hyattsville, Maryland: US Department of Health and Human Services, CDC, 1997.

  7. Horton JA, Cruess DF, Romans MC. Compliance with mammography screening guidelines: 1995 Mammography Attitudes and Usage Study Report. Womens Health Issues 1996;6:239-45.

  8. Lavrakas PJ. Telephone survey methods: sampling selection and supervision. 2nd ed. Newbury Park, California: Sage Publications, 1993.

  9. Crane LA, Kaplan CP, Bastani R, Scrimshaw SC. Determinants of adherence among health department patients referred for a mammogram. Women & Health 1996;24:43-64.

  10. Henson RM, Wyatt SW, Lee NC. The National Breast and Cervical Cancer Early Detection Program: a comprehensive public health response to two major health issues for women. J Public Health Management Practice 1996;2:36-47.

    • Alabama, Arizona, California, Connecticut, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Iowa, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nebraska, New Hampshire, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, and Wisconsin.


+------------------------------------------------------------------- --+ | Erratum: Vol. 46, No. 40 | |             | | In the report, "Self-Reported Use of Mammography Among Women | | Aged greater than or equal to 40 Years -- United States, 1989 and | | 1995," on page 939, the "All women" line in Table 1 should be | | deleted.    | +------------------------------------------------------------------- --+
Table_1
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TABLE 1. Unadjusted and adjusted* percentage of women aged >=40 years who reported having had a mammogram during the 2 years
preceding the interview, by state -- United States, Behavioral Risk Factor Surveillance System (BRFSS), 1989 and 1995 +
========================================================================================================================================
                                              1989                                                       1995
                 ---------------------------------------------------------  ------------------------------------------------------------
                                       Undadjusted             Adjusted                           Unadjusted              Adjusted
                                     ---------------        --------------                       --------------       ------------------
State &          Sample size              %   (SE@)             %    (SE)   Sample size             %     (SE)             %    (SE)
----------------------------------------------------------------------------------------------------------------------------------------
All women             20,511           54.3   (0.6)          54.3   (0.6)        31,394          67.0    (0.4)          70.3   (0.4)

Alabama                  590           49.2   (2.2)          49.1   (2.2)           630          64.5    (2.1)          63.8   (2.1)
Arizona                  455           52.2   (2.6)          52.3   (2.5)           731          71.4    (2.5)          71.2   (2.4)
California               632           57.1   (2.4)          57.9   (2.4)         1,221          74.5    (1.7)          75.3   (1.7)
Connecticut              437           63.0   (2.6)          62.7   (2.6)           625          74.8    (2.0)          74.6   (2.0)
Florida                  588           53.1   (2.2)          52.7   (2.3)         1,241          74.4    (1.4)          74.0   (1.4)
Georgia                  480           53.3   (2.5)          53.3   (2.5)           712          71.0    (1.9)          70.4   (1.9)
Hawaii                   504           60.2   (2.5)          58.6   (2.4)           691          75.3    (2.1)          75.5   (2.1)
Idaho                    597           49.8   (2.3)          50.0   (2.3)           957          63.4    (1.7)          63.9   (1.7)
Illinois                 590           51.1   (2.3)          51.6   (2.3)         1,023          69.9    (1.6)          70.4   (1.6)
Indiana                  720           46.7   (2.1)          46.6   (2.0)           855          64.0    (1.8)          64.6   (1.7)
Iowa                     460           48.3   (2.6)          48.4   (2.6)         1,324          75.0    (1.2)          75.4   (1.1)
Kentucky                 652           50.4   (2.1)          50.1   (2.1)           927          63.3    (1.7)          63.6   (1.7)
Maine                    393           55.0   (2.7)          55.7   (2.6)           459          70.0    (2.4)          71.7   (2.3)
Maryland                 553           60.4   (2.2)          59.5   (2.1)         1,739          75.0    (1.2)          75.4   (1.1)
Massachusetts            356           64.2   (3.0)          64.5   (3.0)           585          78.9    (1.8)          79.7   (1.8)
Michigan                 718           63.9   (2.0)          63.8   (1.9)           835          77.4    (1.5)          77.5   (1.5)
Minnesota              1,013           63.6   (1.6)          64.0   (1.6)         1,280          67.7    (1.4)          69.9   (1.4)
Missouri                 519           48.3   (2.4)          49.7   (2.4)           580          66.9    (2.2)          66.4   (2.2)
Montana                  407           49.8   (2.7)          49.9   (2.7)           424          65.0    (2.5)          65.2   (2.5)
Nebraska                 467           42.7   (2.5)          43.8   (2.5)           669          61.9    (2.1)          63.0   (2.1)
New Hampshire            412           62.4   (2.6)          61.8   (2.7)           494          72.1    (2.2)          72.5   (2.1)
New Mexico               365           56.9   (2.9)          56.5   (2.9)           434          68.6    (2.7)          68.7   (2.6)
New York                 435           51.5   (2.9)          51.4   (2.8)           828          73.6    (1.8)          74.4   (1.7)
North Carolina           614           52.9   (2.4)          52.6   (2.4)         1,208          65.8    (1.5)          65.8   (1.5)
North Dakota             532           59.1   (2.3)          59.4   (2.4)           647          68.0    (2.0)          69.5   (2.0)
Ohio                     482           53.8   (2.5)          53.8   (2.4)           491          68.3    (2.4)          68.1   (2.3)
Oklahoma                 430           59.0   (2.6)          49.8   (2.6)           646          64.5    (2.2)          64.3   (2.2)
Oregon                   608           57.3   (2.2)          57.2   (2.2)         1,021          68.8    (1.6)          71.1   (1.5)
Pennsylvania             618           52.6   (2.2)          53.4   (2.1)         1,251          62.9    (1.6)          63.1   (1.6)
Rhode Island             630           64.5   (2.2)          65.2   (2.2)           565          71.5    (2.2)          71.7   (2.1)
South Carolina           634           50.4   (2.2)          50.4   (2.1)           712          71.0    (1.9)          71.1   (1.9)
South Dakota             555           47.2   (2.3)          47.3   (2.3)           635          61.7    (2.2)          63.1   (2.2)
Tennessee                837           48.2   (1.9)          48.4   (1.8)           698          67.2    (1.9)          67.3   (1.9)
Texas                    454           54.3   (2.6)          54.4   (2.6)           544          64.8    (2.3)          65.6   (2.2)
Utah                     524           51.0   (2.5)          50.9   (2.5)           937          62.9    (2.2)          63.4   (2.1)
Virginia                 406           58.4   (2.9)          57.0   (2.8)           585          72.4    (2.2)          72.5   (2.2)
Washington               474           56.5   (2.4)          57.2   (2.4)         1,072          70.1    (1.5)          71.3   (1.5)
West Virginia            637           45.8   (2.2)          45.2   (2.2)         1,007          65.0    (1.7)          65.3   (1.7)
Wisconsin                363           56.3   (2.8)          57.0   (2.8)           676          63.1    (2.3)          63.5   (2.3)
Range                           (42.7-64.5)           (43.8-65.2)                         (61.7-78.9)            (63.0-79.7)
----------------------------------------------------------------------------------------------------------------------------------------
* Adjusted to the 1989 BRFSS age distribution for women.
+ Denominator includes all female respondents aged >=40 years.
& A total of 39 states participated in BRFSS in 1989 and in 1995.
@ Standard error.
========================================================================================================================================

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