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PubMed1991

Present status of residency training in mammography.

We conducted a telephone interview of all 207 accredited diagnostic radiology residency training programs listed in the American Medical Association's Directory of Graduate Medical Education Programs. Resident training in mammography was offered in 206 programs, and 35% of the programs had initiated this training within the past 3 years. Residents had an assigned block of time to do mammography in 84% of the programs. Of the 206 programs, 40% had rotations devoted exclusively to mammography, with 82% of the exclusive rotations lasting from 4 to 8 weeks. Residents were performing localization procedures in 91% of the programs and dictating cases in 81%. A distinction was made between screening and diagnostic examinations by 35% of the training institutions, at least in terms of the fee for the examination. Radiologists who devoted at least half of their practice to mammography taught in 52% of the programs. The American College of Radiology has granted accreditation in mammography to 29% of the programs. Although almost all accredited residency training programs offer training in mammography, there are some deficiencies in this training. More residents need to gain the experience of dictating mammography reports and need to learn about the distinctions between screening and diagnostic mammography. Despite the anticipated deluge of screening examinations in the next decade, there were only 17 fellowships that included at least 6 months of mammography identified in 15 (7%) of the institutions; only 11 of these were full-time 1-year breast imaging fellowships.

Curriculum↗
PubMed1995

A proposal for a national mammography database: content, purpose, and value.

A national mammography database is a centralized, computerized method of data collection consisting of two possible parts: a national mammography audit and a system for monitoring and tracking patients. A national mammography audit refers to collecting and analyzing medical audit data of individual mammography practices at a national level and is a critical step in improving the interpretive component of mammography. The monitoring and tracking component refers to a centralized system that provides women and physicians with a recruitment and follow-up mechanism to optimize participation in mammography services. Both parts of a national mammography database represent important components in the improvement of mammography quality. However, unique scientific, legal, and fiscal concerns are important to consider before establishing a national mammography database.

Female↗
PubMed2002

Differential value of comparison with previous examinations in diagnostic versus screening mammography.

OBJECTIVE: The purpose of our study was to analyze the differences in clinical outcomes of diagnostic and screening mammography depending on whether comparison is made with previous examinations. MATERIALS AND METHODS: We analyzed 48,281 consecutive mammography examinations for which previous mammography (9825 diagnostic, 38,456 screening) had been performed between 1997 and 2001, collecting data on demographics, whether comparison actually was made with previous examinations, abnormal findings (recall for screening mammography or biopsy recommendation for diagnostic mammography), biopsy yield of cancer, cancer detection rate, size of invasive cancers, axillary nodal status, and cancer stage. RESULTS: Comparison with previous examinations in the incidence screening setting decreases the recall rate from 4.9% to 3.8% (p < 0.0001) but does not significantly affect the biopsy yield (40-44%, p = 0.56) or the cancer detection rate (5.5-5.2/1000, p = 0.87). In the diagnostic setting, comparison with previous examinations increases the biopsy-recommended rate from 4.3% to 9.4% (p < 0.0001), the biopsy yield from 38% to 51% (p = 0.12), and the overall cancer detection rate from 11/1000 to 39/1000 (p < 0.0001). Comparison with previous examinations is not associated with a significant difference in mean tumor size. However, it is associated with a significant decrease in the frequency of axillary node metastasis and the cancer stage for screening mammography, but not for diagnostic mammography. CONCLUSION: For screening mammography, comparison with previous examinations significantly decreases false-positive but not true-positive findings and permits detection of cancers at an earlier stage. For diagnostic mammography, comparison with previous examinations increases true-positive findings.

Biopsy, Needle↗
PubMed2004

Sensitivity of MRI versus mammography for detecting foci of multifocal, multicentric breast cancer in Fatty and dense breasts using the whole-breast pathologic examination as a gold standard.

OBJECTIVE: Our aim was to compare the effectiveness of mammography and MRI in the detection of multifocal, multicentric breast cancer. SUBJECTS AND METHODS: Ninety patients with planned mastectomies (nine bilateral) underwent mammography and dynamic gadolinium-enhanced MRI. Off-site reviewers aware of the entry criterion (planned mastectomy) evaluated both examinations for the presence of malignant foci, recording the density pattern on mammography. The gold standard was pathologic examination of the whole excised breast (slice thickness, 5 mm). RESULTS: Of 99 breasts, pathologic findings revealed 52 unifocal, 29 multifocal, and 18 multicentric cancers for a total of 188 malignant foci (158 invasive and 30 in situ). Overall sensitivity was 66% (124/188) for mammography and 81% (152/188) for MRI (p < 0.001); 72% (113/158) and 89% (140/158) for invasive foci (p < 0.001); and 37% (11/30) and 40% (12/30) for in situ foci (p > 0.05, not significant), respectively. Mammography and MRI missed 64 and 36 malignant foci, respectively, with median diameters of 8 and 5 mm (p = 0.033) and an invasive-noninvasive ratio of 2.4:1 (45:19) and 1.0:1 (18:18) (p = 0.043), respectively. The overall positive predictive value (PPV) was 76% (124/164) for mammography and 68% (152/222) for MRI (not significant). In breasts with an almost entirely fatty pattern, sensitivity was 75% for mammography and 80% for MRI (not significant), and the PPV was 73% and 65% (not significant), respectively. In breasts with fibroglandular or dense pattern, the sensitivity was 60% and 81% (p < 0.001), and the PPV was 78% and 71% (not significant), respectively. CONCLUSION: MRI was more sensitive than mammography for the detection of multiple malignant foci in fibroglandular or dense breasts. Mammography missed larger and more invasive cancer foci than MRI. A relatively low PPV was a problem for both techniques.

Adipose Tissue↗
PubMed2005

The incremental contribution of clinical breast examination to invasive cancer detection in a mammography screening program.

OBJECTIVE: The objective of this study was to determine the potential added contribution of clinical breast examination (CBE) to invasive breast cancer detection in a mammography screening program, by categories of age and breast density. SUBJECTS AND METHODS: We prospectively followed 61,688 women aged 40 years or older who had undergone at least one screening examination with mammography and CBE between January 1, 1996, and December 31, 2000, for 1 year after their mammogram for invasive cancer. We computed the incremental sensitivity, specificity, and positive predictive value of CBE over mammography alone for combinations of age and breast density (predominantly fatty or dense). RESULTS: Mammography sensitivity was 78% and combined mammography-CBE sensitivity was 82%, thus CBE detected an additional 4% of invasive cancers. CBE detected a minority of invasive cancers compared with mammography for all age groups and all breast densities. Sensitivity increased from adding CBE to screening mammography for all ages, from 6.8% in women ages 50-59 with dense breasts to 1.8% in women ages 60-69 years with fatty breasts. CBE generally added incrementally more to sensitivity among women with dense breasts. Specificity and positive predictive value declined when CBE was used in conjunction with mammography, and this decrement was more pronounced in women with dense breasts. CONCLUSION: CBE had modest incremental benefit to invasive cancer detection over mammography alone in a screening program, but also led to greater risk of false-positive results. These risks and benefits were greater in women with dense breasts. The balance of risks and benefits must be weighed carefully when evaluating the inclusion of CBE in a screening examination.

Adult↗
PubMed2002

The Canadian National Breast Screening Study-1: breast cancer mortality after 11 to 16 years of follow-up. A randomized screening trial of mammography in women age 40 to 49 years.

BACKGROUND: The efficacy of breast cancer screening in women age 40 to 49 years remains controversial. OBJECTIVE: To compare breast cancer mortality in 40- to 49-year-old women who received either 1) screening with annual mammography, breast physical examination, and instruction on breast self-examination on 4 or 5 occasions or 2) community care after a single breast physical examination and instruction on breast self-examination. DESIGN: Individually randomized, controlled trial. SETTING: 15 Canadian centers. PARTICIPANTS: 50 430 volunteers age 40 to 49 years, recruited from January 1980 to March 1985, who were not pregnant, had no previous breast cancer diagnosis, and had not had mammography in the preceding 12 months. INTERVENTIONS: Breast physical examination and instruction on breast self-examination preceded random assignment of 25 214 women to receive mammography and annual mammography, breast physical examination, and breast self-examination and 25 216 women to receive usual community care with annual follow-up. MEASUREMENTS: Verified breast cancer incidence and cohort mortality through 31 December 1993 and deaths from breast cancer through 30 June 1996. RESULTS: The 105 breast cancer deaths in the mammography group and 108 breast cancer deaths in the usual care group yielded a cumulative rate ratio, adjusted for mammography done outside the study, of 1.06 (95% CI, 0.80 to 1.40). A total of 592 cases of invasive breast cancer and 71 cases of in situ breast cancer were diagnosed by 31 December 1993 in the mammography group compared with 552 and 29 cases, respectively, in the usual care group. The expected proportions of nonpalpable and small invasive tumors were detected on mammography. CONCLUSION: After 11 to 16 years of follow-up, four or five annual screenings with mammography, breast physical examination, and breast self-examination had not reduced breast cancer mortality compared with usual community care after a single breast physical examination and instruction on breast self-examination. The study data show that true effects of 20% or greater are unlikely.

Adult↗
PubMedDate not supplied

Cost-effectiveness of strategies to enhance mammography use.

OBJECTIVE: To estimate the cost-effectiveness of three strategies to increase breast cancer screening with mammography (reminder postcard, reminder telephone call, and motivational telephone call). DESIGN: Cost accounting for each strategy followed by cost-effectiveness analysis. DATA SOURCE FOR EFFECTIVENESS: Randomized trial of three strategies conducted at Group Health Cooperative of Puget Sound (GHC). TARGET POPULATION: Women 50 to 79 years of age who were enrolled in GHC's breast cancer screening program who did not schedule screening mammography within 2 months after it was recommended by letter. PERSPECTIVE: Health plan. OUTCOME MEASURE: Marginal cost-effectiveness of each additional woman screened. RESULTS OF BASE-CASE ANALYSIS: Because of its high cost (about $26 per call) and intermediate effectiveness, the motivational call was the least cost-effective strategy. If it was assumed that 50% of the women who scheduled mammography after receiving the reminder postcard would have scheduled mammography within 10 months even without it, marginal cost-effectiveness for the postcard among all women was $22 per woman screened versus $92 for the reminder call. Among women with no previous mammography, the marginal cost-effectiveness for the postcard was $70 versus $100 for the reminder call. RESULTS OF SENSITIVITY ANALYSIS: Among women with no previous mammography, the choice between the reminder postcard and the reminder call was sensitive to assumptions about the percentage of women expected to receive mammography in the absence of other promotional strategies. CONCLUSIONS: A simple reminder postcard is the most cost-effective way to increase mammography. Choices about how to promote mammography will ultimately depend on plan values and willingness to invest in promotional strategies that increase participation at higher unit costs.

Aged↗
PubMed2005

Mammography use.

OBJECTIVES: The goal of this study was to compare mammography use in Haitian women versus that of other racial/ethnic groups in the same neighborhoods and to identify factors associated with mammography use in subpopulations that are seldom studied. METHODS: A community-based, cross-sectional survey sampled a multiethnic group of inner-city women from eastern Massachusetts. Bivariate analyses and logistic regression models were used to predict lifetime and recent (within two years) mammography screening. RESULTS: Self-reported lifetime mammography use was similar for Haitian (82%), African-American (78%), Caribbean (81%) and Latina women (86%) but higher for white women (94%, p = 0.008). Mammography use in the past two years was also similar in all groups (66-82%, p = 0.41). In multivariate models, African-American (adjusted odds ratio [AOR]; 0.3; 95% CI 0.1-0.9) and Haitian women (AOR 0.3; 95% CI 0.1-0.9) had lower odds of lifetime mammography compared to white women. Factors independently related to lifetime and recent mammography included having a regular healthcare provider, greater knowledge of breast cancer screening; higher education, and private health insurance. CONCLUSIONS: Haitian women with a regular provider and knowledge of breast cancer screening reported recent mammography use similar to women from other racial/ethnic groups. The racial/ethnic patterns of mammography use in our study do not explain racial/ethnic differences in breast cancer stage or mortality.

Adult↗
PubMedDate not supplied

Multistrategy health education program to increase mammography use among women ages 65 and older.

Mammography use decreases with age although the risk of breast cancer increases with age. Medicare now provides biennial coverage for screening mammography. This study was designed to simulate the Medicare condition by subsidizing mammography among women in eight retirement communities in the metropolitan Philadelphia area. The study also measured the impact of health education interventions and the presence of a mobile mammography van on increased use of mammography. Retirement communities were assigned randomly to the control (cost subsidy alone) or experimental group (cost subsidy, mammography van, and tailored health education interventions). A total of 412 women ages 65 and older who had not had mammograms in the previous year were surveyed at baseline and 3 months later. Analytic techniques reflected the cluster nature of the randomization. Women in the experimental group were significantly more likely than the control group women to have obtained mammograms. Forty-five percent of the experimental group women compared with 12 percent of the control group women subsequently had mammograms in the 3 months after the baseline interview (P less than .001). Logistic regression analysis for mammography use indicated an odds ratio of 6.1 associated with being in the experimental group. For women in the experimental group, a separate logistic regression for mammography use showed an odds ratio of 7.8 associated with attendance at the educational presentation. The results suggest that Medicare coverage alone will not increase mammography use sufficiently to achieve year 2000 objectives. However, the addition of access enhancing and health education interventions boosts utilization dramatically.

Aged↗
PubMed1992

The politics of mammography.

Mammography has had a major impact on the earlier detection, treatment options, and management decisions and survival and mortality rates of breast cancer. Consequences include overwhelming demand for mammography; problems with optimum response by radiology; limited availability of the examination, especially to the socioeconomically disadvantaged; self-referral for mammography by unqualified physicians for less than altruistic reasons; and unrealistic expectations of mammography by women, physicians, and lawyers. Responses to the overwhelming demand for high-quality mammography include ACR postgraduate and continuing education courses and its mammography accreditation program; a more comprehensive examination on mammography for certification by the ABR; and increasing state and federal government interest and legislation for reimbursement, quality assurance, and delivery of mammography. The precedents this sets for radiology if not all of medicine suggests that collaboration of the private and public sectors offers the greatest promise of an appropriate response, namely reproducible optimum mammography accurately interpreted with the lowest possible radiation dose for all eligible women in the United States.

Breast Neoplasms↗
PubMed1991

Effect of continuing medical education and cost reduction on physician compliance with mammography screening guidelines.

BACKGROUND: Primary care physicians perform breast cancer screening in women aged 50 years and older less frequently than recommended by national guidelines. METHODS: A multimethod continuing medical education (CME) intervention was tested in an attempt to increase breast cancer screening practices in a predominantly fee-for-service practice community in New York State. Preintervention and postintervention surveys of primary care physicians were conducted in 1988 and 1990, respectively. Project-initiated, low-cost mammography in one town and the unanticipated provision of free mammography services in another town under nonproject auspices permitted a comparison to be made between these towns and towns where mammography screening was provided at the prevailing fees to determine the impact that cost has on physicians' referral of women patients for mammography. RESULTS: Physicians practicing in the towns in which the CME intervention was provided showed a significant increase, consistent across specialty groups and greatest among family physicians, in the number of reported mammography referrals of asymptomatic women aged 50 to 75 years. Changes in the CME control town were smaller and not statistically significant for the sample size available. The increase in compliance was as large in the CME-intervention towns, one without (19%) and one with low-cost mammography (20%), as the increase in the town with free mammography alone (18%). There were no significant increases in reported performance of breast examination. CONCLUSIONS: A multimethod program of CME is a feasible approach to increasing community physician compliance with mammography screening guidelines, particularly among family physicians, and can enhance the impact of reduced cost or have at least the equivalent effect of free mammography services.

Aged↗
PubMedDate not supplied

Fee structure as a determinant of patient's choice to undergo mammography.

Mammography, although an effective screening tool, has generally been underutilized. Although many factors may contribute to low utilization rates, the degree to which fee structure influences women's decision to have mammography has not been determined. This study compared women having mammography at the regular fee with those women having mammography at a special reduced rate. The study group consisted of all women having mammography for eight consecutive months at a new mammography screening clinic. The clinic had specifically been established for self-referral. Women from both groups when compared to the general population in the surrounding area tended to be in a higher educational/socioeconomic level. Women in the regular fee group reported physician influence as being most important in their decision to have mammography while women in the reduced fee group reported the reduced fee of mammography itself as the most important factor. Books and magazines were the second most important factor for both the regular and reduced fee group with regard to their decision to have mammography.

Adult↗
PubMed1995

Effect of distance and travel time on rural women's compliance with screening mammography: an UPRNet study. Upper Peninsula Research Network.

BACKGROUND: The purpose of this study was to determine whether the distance and time required for rural women to travel for a mammogram is associated with their compliance with screening mammography recommendations. METHODS: Women who were > or = 40 years old and visiting family physician offices for any reason were given a questionnaire regarding their frequency of mammography during the past 4 years, the distance and travel time from their homes to the nearest mammography unit, their attitudes and knowledge about mammography, and demographics. The study was conducted in the 12 family practices of the Upper Peninsula Research Network (UPRNet), a Michigan rural family practice research network. RESULTS: Eighty-eight percent (N = 416) of the women in the study had previously had mammography, but 41% were not compliant with American Cancer Society guidelines regarding mammography screening. After controlling for confounding, none of the measures of travel time or distance were associated with mammography compliance. CONCLUSIONS: In this rural population, mammography compliance is not affected by distance, travel time, or transportation. A population-based study in a more remote area is needed to further explore geographic barriers to mammography compliance among rural women.

Adult↗
PubMed1994

Beliefs about breast cancer and mammography by behavioral stage.

PURPOSE/OBJECTIVES: To explore the relationships of Health Belief Model (HBM) variables and the Trans-theoretical Model with regard to behavioral stage of mammography adoption. DESIGN: Descriptive, correlational. SETTING: Large midwestern city. SAMPLE: 405 women over age 40 obtained through random digit dialing. Subjects had agreed to participate in a larger intervention study. METHODS: Data were collected during in-home interviews. Subjects completed six scales developed from the HBM and answered questions related to mammography compliance. MAIN RESEARCH VARIABLES: Perceptions of breast cancer susceptibility and seriousness, perceived benefits of and barriers to mammography, motivation to stay healthy, and perceived control over health; degree of mammography compliance. FINDINGS: Women complaint with mammography guidelines had significantly higher scores on seriousness, benefits, health motivation, and control as well as significantly lower scores on barriers. In addition, scores on susceptibility, seriousness, benefits, barriers, and health motivation were significantly different across stages of mammography (precontemplation, contemplation, and action/maintenance). CONCLUSIONS: Interventions should target attitudes about susceptibility and seriousness of breast cancer in women who do not comply with established guidelines for mammography. Women who are not in compliance and have no plans to seek mammography would benefit from additional emphasis on mammography benefits and from removal of barriers. Health motivation also must be addressed in noncompliant women. IMPLICATIONS FOR NURSING PRACTICE: These results promise to expand the understanding of a person's motivation to change health-seeking behaviors, specifically obtaining routine screening mammograms. Further research using this new framework is needed to substantiate these results with a cross section of women.

Adaptation, Psychological↗
PubMed1993

Positive predictive value of screening mammography by age and family history of breast cancer.

OBJECTIVE: To determine the positive predictive value (PPV) of low-cost screening mammography according to age and family history of breast cancer. DESIGN: Cross-sectional. SETTING: Six counties in northern California. PARTICIPANTS: A total of 31,814 women aged 30 years and older referred for mammography to the University of California, San Francisco, Mobile Mammography Screening Program from April 18, 1985, through November 20, 1992. MEASUREMENTS: Breast cancer risk profile, two standard mammographic views per breast, and follow-up of abnormal screening examinations. RESULTS: Although women aged 50 years or older constituted only 38.3% of all women who received first-screening mammography, 74% of breast cancers were detected in this group. Ten cancers were diagnosed per 1000 first-screening examinations in women aged 50 years or older, with 14.8 diagnostic procedures per cancer diagnosed compared with two cancers per 1000 screening examinations and 48.3 diagnostic tests per cancer diagnosed in women younger than 50 years. The PPV of first-screening mammography (number of breast cancers detected per abnormal examination) increased with age: .03 for those aged 30 to 39 years; .04 for those aged 40 to 49; .09 for those aged 50 to 59; .17 for those aged 60 to 69; and .19 for those aged 70 years or older (chi 2 for trend, P < .001). Women aged 50 to 59 years had a higher PPV for first-screening mammography than women aged 40 to 49 years (.09 vs. .04; P = .004), and women with a family history of breast cancer had higher PPVs compared with women without history (40 to 49 years of age, .13 vs .04, P = .01; and 50 to 59 years of age, .22 vs .09, P = .01). CONCLUSION: Five times as many cancers per 1000 first-screening mammographic examinations were diagnosed in women aged 50 years or older compared with women aged less than 50 years. The highest PPVs for mammography were in women aged 50 years or older and in women aged 40 years or older with a family history of breast cancer. Efforts to promote screening mammography should focus on women in these groups, in whom the majority of breast cancers occur and for whom mammography has the highest PPVs.

Adult↗
PubMed1993

[Evaluation of radiation doses in mammography].

A dedicated X-ray mammography was introduced to our hospital from 1987 and an imaging receptor of xeroradiography was applied. We reported previously that the average air exposure was 0.79R and that the absorption dose of skin was 1.00 rad. These data are similar to literature reports. Screen-film mammography was introduced recently. To select the best breast imaging and the least radiation exposure, diverse methods were investigated. A dosimetry (Capintec model 192) and a PS-033 parallel ionization chamber were applied to compare the absorption dose on polystyrene phantom between various exposure factors, the application of breast clamp and the size of exposure field. Retrospective estimation of the radiation dose was obtained from the exposure factors of previous mammography since July, 1990 to May, 1992. There were 1035 xeromammographic examinations and 358 examinations with medium-speed screen-film mammography. Another 61 craniocaudal and 96 mediolateral projections with high-speed screen-film mammography were recruited during the recent two months. An ionization chamber (Exradin, Shonka-Wyckoff A5) with an electrometer (Keithley 617) wer selected to obtain the dose equivalent from air exposure between selected exposure factors. The radiation dose of mammography is linearly correlated with voltage/kV and current/mAs. The application of a breast clump reduces 10% of the skin dose. The average exposure factors of xeromammography are 45.6 kV, 163.5 mAs. These results remain the same as in our previous report. Xeromammography has a greater exposure to air, estimated average glandular dose and absorbed dose than screen-film mammography. The mean exposure factor of rapid screen-film mammography gains half the value of medium screen-film mammography, ie. 26.6 kV, 87.0 mAs vs. 26.0 kV, 164.5 mAs.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMedDate not supplied

[The diagnostic accuracy of a digital mammography system with photostimulable storage phosphors used with automatic reading].

Even though digital mammography might potentially yield major advantages in management, biology and diagnosis, state-of-the-art digitalization is still in a clinical experimental phase. To assess the diagnostic accuracy of a digital mammography system with storage phosphors, we analyzed 320 digital and 320 conventional mammograms acquired in lateral-oblique projection in the same patients. Digital mammography capabilities in identifying and characterizing breast lesions were compared with those of conventional mammography; the presence/absence of lesions and their benign/malignant nature were investigated. Complete conventional mammography was our gold standard. The digital system did not miss any malignant lesion but it did miss some benign lesions (focal masses) which had been depicted with conventional mammography, especially small low-contrast opacities. Microcalcifications were better depicted on digital images which showed, at the same time, tissues of different density, thanks to their wider dynamic range. Digital mammography yielded a false positive result on a cluster of microcalcifications, because its spatial resolution is lower. The diagnostic yield of digital mammography was poorer only in the detection of small low-contrast lesions and in the characterization of microcalcifications. To conclude, in our experience, the storage phosphor system seems to be suitable for clinical mammography, but only with careful monitoring; in contrast, we think it is not yet suitable for screening purposes.

Adult↗
PubMed1996

Factors determining compliance with screening mammography.

OBJECTIVE: To determine factors affecting compliance with screening mammography prescribed by family physicians. DESIGN: Secondary analysis of a nonrandomized trial. SETTING: University-affiliated family medicine clinic in Montreal. PATIENTS: Women aged 50 to 69 years who were given a written prescription for a screening mammography during their visit at the clinic between Oct. 12, 1991, and May 31, 1992, and who had not undergone mammography in the preceding 2 years and had never been treated for breast cancer. Information on the potential factors was obtained through a telephone questionnaire 2 months after the visit. OUTCOME MEASURES: Indicator of compliance presence of result of screening mammography in patient chart, potential factors influencing compliance: age, level of education, marital status, socioeconomic level, smoking status, perceived health status, perceived psychological well-being, risk factors for breast cancer, use of health services including frequency of Papanicolaou test, Health Belief Model variables. RESULTS: Of the 171 eligible women, 113 (66.1%) underwent the prescribed mammography within 2 months after the visit to the clinic, and 149 (87.1%) responded to the questionnaire. The patients' socioeconomic characteristics, perceived health status, health utilization indices and risk factors for breast cancer were not found to be predictors of compliance. The strongest predictor of compliance was the number of previous mammograms. Women who had undergone mammography previously were less likely to be noncompliant than those who had not (odds ratio [OR] 0.11, 95% confidence interval [CI] 0.02 to 0.51; p = 0.005). Women who did not comply were less likely than those who did to believe that a prescription from their physician would convince them to undergo mammography (OR 0.21, 95% CI 0.007 to 0.60; p = 0.004). Other factors associated with noncompliance were the expression of fear of mammography (OR 2.09, 95% CI 1.08 to 4.02; p = 0.03) and the lack of time to take the test (OR 3.07, 95% CI 1.21 to 7.80 p = 0.02). Being a smoker was negatively associated with compliance (OR 0.43; 95% CI 0.22 to 0.86; p = 0.02). The stepwise logistic regression model accounted for 87.5% of the outcome (chi2 for goodness of fit = 164.4; p = 0.0001). CONCLUSION: Family physicians who prescribe screening mammography, even to women who consult for other reasons, are likely to overcome some of the barriers observed in association with population screening rates. However, physician-oriented approaches are not likely to reach the 30% to 40% of reluctant women who appear to hold negative views toward physicians' recommendations. Further study is necessary to determine how better to reach these women.

Aged↗