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PubMed1998

Health status and mammography use among older women.

OBJECTIVE: To assess the extent to which an age-associated reduction in mammography use can be explained by declining self-reported health status. DESIGN: We analyzed data from the 1992 National Health Interview Survey (NHIS) and Cancer Control Supplement. Logistic regression analysis was used to evaluate the association between age, health status (self-reported health and limitations in major activity), and other variables potentially related to mammography use within the past 1 year (recent mammography). PARTICIPANTS: Of 12,035 NHIS respondents we restricted our analysis to the 1,772 women aged 50 years or older who reported one or more lifetime mammograms. We excluded women without a mammogram (n = 937) because we were interested in factors related to recent use versus past use of mammography. MEASUREMENTS AND MAIN RESULTS: The percentage of women with a recent mammogram declined with increasing age, and the age association was independent of other factors including health status (adjusted odds ratio [OR] comparing women aged 75 years or older with those aged 50 to 64 years was 0.54; 95% confidence interval [CI] 0.41, 0.70). This age effect persisted in an analysis restricted to women reporting good or better health (adjusted OR was 0.60, 95% CI 0.44, 0.80). CONCLUSION: The observed decline in recent mammography use with advancing age was not explained by variation in health status. Because healthy elderly women may live long enough to realize the potential benefit of screening mammography, factors responsible for its reduced use should be identified. Doing so will allow for the selective promotion of screening mammography among those older women most likely to benefit.

Age Factors↗
PubMed2003

Beliefs and expectations of women under 50 years old regarding screening mammography: a qualitative study.

OBJECTIVE: Because shared decision making has been recommended for screening mammography by women under age 50, we studied women's decision-making process regarding the procedure. DESIGN: Qualitative research design using in-depth semi-structured interviews. PATIENTS: Sixteen white and African-American women aged 38 to 45 receiving care at a large New England medical practice. MEASUREMENTS AND MAIN RESULTS: We identified the following content areas in women's decision-making process: intentions for screening, motivating factors to undergo screening, attitudes toward screening mammography, attitudes toward breast cancer, and preferences for information and shared decision making. In our sample, all women had or intended to have a screening mammogram before age 50. They were motivated by the awareness of the recommendation to begin screening at age 40, knowing others with breast cancer, and a sense of personal responsibility for their health. Participants feared breast cancer and thought the benefits of screening mammography far outweighed its risks. Women's preferences for involvement in decision making varied from wanting full responsibility for screening decisions to deferring to their medical providers. All preferred the primary care provider to be the main source of information, yet the participants stated that their own providers played a limited role in educating them about the risks and benefits of screening and the mammography procedure itself. Most of their information was derived from the media. CONCLUSIONS: The women in this study demonstrated little ambivalence in their desire for mammography screening prior to age 50. They reported minimal communication with their medical providers about the risks and benefits of screening. Better information flow regarding mammography screening is necessary. Given the lack of uncertainty among women's perceptions regarding screening mammography, shared decision making in this area may be difficult to achieve.

Adult↗
PubMed2000

[Full-field digital mammography: dose-dependent detectability of breast lesions and microcalcinosis].

OBJECTIVES: The study compares contrast-detail and microcalcification detectability of a full-field digital mammography (FFDM) to a state-of-the-art conventional screen-film mammography (SFM) by using different doses in the digital system. MATERIALS AND METHODS: The investigations were performed with an FFDM (Senographe 2000 D, GEMS) and an SFM system (Senographe DMR, GEMS) using a contrast-detail mammography phantom (CDMAM) and an anthropomorphic breast phantom with superimposed microcalcifications. The digital detector was exposed with standard dose of SFM and with a dose reduction of up to 75%. Contrast-detail curves and correct observation ratio (COR) were performed for the CDMAM phantom. ROC analysis with a confidence level ranging from 1 to 5 was done with the results of the anthropomorphic phantom. RESULTS: Digital mammography with the same dose revealed at least an equivalent or even higher detectability rate than conventional mammography, COR could be increased at about 10-25%. The ROC analysis yielded better results for the FFDM system. The same lesion detectability in digital mammography as in the conventional method was reached at a dose reduction of about 25%, concerning spot views even at higher reduction. Dose reduction in the anthropomorphic phantom resulted in a linear loss of detectability. The same detectability as in conventional mammography was reached, however, by a dose reduction of about 50%. CONCLUSION: The results suggest that FFDM is at least equivalent to or--as far as spot views are concerned--superior to conventional SFM concerning the detectability of simulated lesions. Thus, a potential of dose reduction is suggested.

Breast Diseases↗
PubMed1998

Age-related differences in mammography use and in breast cancer knowledge, attitudes, and behaviors.

BACKGROUND: This study examined age differences in breast cancer knowledge, attitudes, and early-detection behaviors in a multi-ethnic sample of economically disadvantaged women participating in a breast-cancer education outreach program. METHODS: Age differences in breast cancer knowledge, perceptions of risk of breast cancer, barriers to mammography, recommendations of mammography by health professionals, health promotion behaviors, and mammography use and intention were investigated. The subjects were 139 women aged 30 or older who were categorized in one of three age groups: 30 to 39, 40 to 49, and 50 years old or older. RESULTS: One fourth of the women between the ages of 30 and 39 reported both that they had had mammography in the past and that they intended to have it in the next year. Fifty percent of those in their forties reported mammography use at some time in the past, and 56% intended to obtain it in the coming year. Fifty percent of those 50 or older reported that they had had mammography in the past year. Women aged 40 or older were more likely than those in their thirties to report that their healthcare providers had encouraged them to get mammograms. No significant age differences were observed in breast cancer knowledge or perceptions of personal risk of breast cancer. CONCLUSION: The fact that the three age groups were similar in their perceptions of personal risk of breast cancer suggests that older women may not be accurately assessing their risk and thus may be obtaining screening mammography at less-than-optimal levels.

Adult↗
PubMed1998

Characteristics of underserved women who did and those who did not use a free/low-cost voucher as part of a mammography screening program.

BACKGROUND: Several programs have been designed to improve mammography screening participation in high-risk populations. The purpose of this cross-sectional study was to assess factors related to participation in a low-cost mammography screening voucher program. METHODS: The methods involved mailing a standardized survey to 101 participants in a low-cost mammography screening voucher program. The survey was designed to yield responses about the use of free mammography vouchers, women's knowledge of breast cancer, their perceptions of their risk of getting the disease, the usefulness of mammography and breast self-examinations, their information-seeking patterns, and general demographic information. RESULTS: Though knowledge and perceptions did not differ significantly between those who did and did not use the vouchers, voucher users were significantly older (47 versus 40) and were more likely to have established patterns of previous mammography use. CONCLUSION: Voucher programs can influence women to obtain mammography, though probably not those at greatest risk of non-adherence.

Adult↗
PubMedDate not supplied

MASTOS: Mammography Simulation Tool for design Optimization Studies.

Mammography is a high quality imaging technique for the detection of breast lesions, which requires dedicated equipment and optimum operation. The design parameters of a mammography unit have to be decided and evaluated before the construction of such a high cost of apparatus. The optimum operational parameters also must be defined well before the real breast examination. MASTOS is a software package, based on Monte Carlo methods, that is designed to be used as a simulation tool in mammography. The input consists of the parameters that have to be specified when using a mammography unit, and also the parameters specifying the shape and composition of the breast phantom. In addition, the input may specify parameters needed in the design of a new mammographic apparatus. The main output of the simulation is a mammographic image and calculations of various factors that describe the image quality. The Monte Carlo simulation code is PC-based and is driven by an outer shell of a graphical user interface. The entire software package is a simulation tool for mammography and can be applied in basic research and/or in training in the fields of medical physics and biomedical engineering as well as in the performance evaluation of new designs of mammography units and in the determination of optimum standards for the operational parameters of a mammography unit.

Algorithms↗
PubMed2004

Breast implant adverse events during mammography: reports to the Food and Drug Administration.

OBJECTIVE: To characterize reports of adverse events occurring during mammography to women with breast implants submitted to the Food and Drug Administration (FDA). METHODS: We searched the adverse events database for any report on silicone gel breast implants or saline breast implants that included the word "mammography" or "mammogram"in the text. We also searched adverse event reports for mammographic equipment that included the term "breast implant" in the text. RESULTS: We retrieved 714 adverse event reports using this strategy. Sixty-six of these reports detailed an adverse event that occurred during mammography or described breast implant interference with mammography. The majority of these reports, 41 of 66 (62.1%), described breast implant rupture during mammography. Other adverse events reported included mammographic compression crushing implants, pain during mammography attributed to implants, inability to perform mammography because of capsular contracture or fear of implant rupture, and delayed detection of cancer attributed to implants. CONCLUSIONS: It is important that women considering breast implants be informed of these potential risks and that clinicians, radiologists, and mammographic technicians keep them in mind when imaging women with implants.

Breast↗
PubMed2002

Mammography uptake predictors in older women.

BACKGROUND: In women aged under 65 years, socio-economic factors and general health behaviours are important predictors of mammography uptake. Little is known about whether these factors are important in older women. OBJECTIVE: To examine a broad range of mammography uptake predictors in women aged 65 and older registered with a London (UK) practice. METHODS: A survey of all female patients aged 65 and over (n = 613) in a south London practice included questions on mammography and cervical screening, general health and functional ability, socio-economic factors, mental health, health behaviours, and attitudes to health. Associations between mammography uptake and other factors were examined using logistic regression. RESULTS: The response rate was 70% (432/613). Increased age was strongly associated with decreased mammography uptake. Additionally, socio-economic factors and general health behaviours (previous cervical smear, drinking alcohol and being a non-smoker) were independently predictive of mammography uptake. Measures of physical and mental health and health attitudes were not independent predictors. Restricting analyses to the oldest women, outside the national screening programme, gave very similar results. CONCLUSIONS: In this sample of older women, socio-economic factors and general health behaviours were more predictive of mammography uptake than measures of physical and mental health or attitudes to health. Knowledge of these predictors is of increasing importance as the screening programme in the UK is extended up to age 70.

Age Factors↗
PubMed1992

Case-control study of factors associated with failure to detect breast cancer by mammography.

BACKGROUND: Although mammography is widely used to detect breast cancer, it is recognized that not all cancers can be seen on mammographic images. PURPOSE: Our purpose was to examine factors associated with failure to detect breast cancer by mammography. METHODS: A case-control study was carried out in which subjects in whom histologically verified breast cancer was not detected by mammography (false negatives) were contrasted with subjects in whom breast cancer had been detected by mammography (true positives). Mammograms from individuals with histologically confirmed breast cancer were classified independently by two radiologists who were unaware of the clinical or other characteristics of the subjects. Histologic slides of all tumors were reviewed by one pathologist. RESULTS: Three variables were found to be independently and significantly associated with failure to detect breast cancer by mammography. Breast cancer was less likely to be detected by mammography in the presence of extensive parenchymal densities (odds ratio [OR] = 9; 95% confidence interval [CI] = 1.8-44.3), a tumor of lobular histology (OR = 7; 95% CI = 2.2-22.1), and tumors of small size (OR = 0.10; 95% CI = 0.0-0.9). CONCLUSION: Our results indicate that biologic factors are associated with failure to detect some breast cancers by mammography and indicate directions for future research in breast imaging.

Adult↗
PubMed1999

Health beliefs, health locus of control, and women's mammography behavior.

Research has shown that routine mammography screening can significantly reduce mortality from breast cancer. The use of mammography screening, however, remains well below national goals. In an effort to understand the factors that influence women's mammography behaviors, this study explored the relation between health beliefs, locus of control, and women's mammography practice. Survey instruments used were Champion's health belief scales and the Multidimensional Health Locus of Control (MHLC) scales. The study used a convenience sample of 25 African Americans and 72 white women ages 35 to 84. Findings showed that women who participated in mammography screening were significantly more likely to perceive greater benefits, greater health motivation, and fewer barriers to screening than those who did not participate. These same three variables were similarly associated with greater frequency of receiving mammograms. It also was found that perceived benefits and health motivation were significantly correlated with shorter duration of time since the last mammogram. No support was found for perceived susceptibility, perceived seriousness, and health locus of control as predictors of women's mammography behavior. Implications for nursing research in further examining the MHLC and the Health Belief Model construct of susceptibility as they relate to mammography behavior are identified. Practice implications for nurses are suggested.

Adult↗
PubMed1993

Patterns of use of mammography among inner-city Detroit women: contrasts between a health department, HMO, and private hospital.

This study assessed the pattern of utilization of mammography among 2,880 inner-city minority women 40 years of age or older who received ongoing primary care services during 1988 or 1989 at four practice sites operated by a health department (two sites), Health Maintenance Organization (HMO), and private hospital. Mammography referral could be documented for 23% to 32% of age eligible women and completed mammograms for 15% to 26%. Among women without a mammogram, 85% had never been referred while 15% were referred but unable to complete the procedure. In multiple logistic regression analysis, factors associated with mammography include age less than 70 years, presence of a breast cancer risk factor and more frequent clinic visits. Mammography was somewhat more frequent at the HMO and hospital clinic than at the health department, but this relationship varied with the women's previous visit and mammography experience. At sites serving uninsured women, mammography use was not associated with the presence or absence of health insurance. It is concluded that the underutilization of mammography is a substantial barrier to the early detection of breast cancer in each of the three different health care organizations studied, and that interventions to improve breast cancer control should focus upon facilitating physician referral practices.

Adult↗
PubMed2000

Underutilization of mammography in older breast cancer survivors.

BACKGROUND: Annual mammography is recommended for all breast cancer survivors. OBJECTIVES: To elucidate mammography use among older survivors of breast cancer and to explore determinants of such use. RESEARCH DESIGN: Retrospective cohort study using data from the Surveillance, Epidemiology, and End Results (SEER) registry linked to Medicare claims. SUBJECTS: A cohort of 3885 breast cancer survivors aged > or =65 years diagnosed with early-stage breast cancer in the United States in 1991. MEASURES: Medicare mammogram claims during the 2-year period following initial breast cancer treatment. RESULTS: Overall, 62% of the cohort underwent annual mammography, 23% underwent mammography in 1 of 2 years, and 15% had no mammography claim in the 2 years evaluated. Twenty-two percent of the women who underwent breast-conserving surgery (BCS) without radiotherapy had no mammogram in the 2-year period evaluated, compared with 17% of those who underwent mastectomy and 4% of those who underwent BCS with radiotherapy. In multivariate analyses controlling for age, cancer stage, and other patient factors, the use of annual mammography was significantly lower among women treated with mastectomy or BCS without radiotherapy than among women treated with BCS with radiotherapy. CONCLUSIONS: Mammography is underused in the follow-up care of older breast cancer survivors. Underuse is of particular concern in women treated with BCS without radiotherapy because of the high risk of local disease recurrence. It is unknown whether poorer follow-up care contributes to the previously described lower rate of long-term survival among women who received this therapy.

Aged↗
PubMedDate not supplied

Testing the theory of planned behavior to predict mammography intention.

BACKGROUND: Louisiana ranks 50th as the least healthy state in the United States. Although limited healthcare access may explain part of the health disparity related to mammography utilization, there is no research to elucidate mammography intention among rural Southeastern Louisiana women. OBJECTIVE: To test the Theory of Planned Behavior to predict mammography intention among rural women in Southeastern Louisiana. METHODS: A correlation study design with multiple regression and path analysis was used. The sample consisted of 302 women, between the ages of 40-74 who were without a prior history of breast cancer, able to read English, and able to respond to a written questionnaire. RESULTS: Path analysis confirmed the direct and indirect relationships of mammography intention (chi2 = 26.2, p > .10, Comparative Fit Index =.968). Regression analysis computed the model path coefficients ranging from beta .176 to .640. Overall, the Theory of Planned Behavior explained 24% of the variance. DISCUSSION: Perceived behavioral control was the strongest predictor of mammography intention. A woman's attitude towards mammography and referent motivation needs further explanation prior to the development of an intervention to increase mammography intention and use.

Adult↗
PubMed1999

Use of mammography among women residing in Spanish provinces with breast cancer screening programmes.

The objective of this study was to measure use of mammography and associated factors among women living in Spanish provinces with breast cancer screening programmes. From a cross-sectional population survey in a representative sample of Spanish women aged 40-70 years, we selected all women aged 45-65 living in provinces with breast cancer screening programmes (336 women). The programmes invited women in this age group to have a mammogram every 2 years. Data were collected by oral interviews in 1994. Use of mammography was defined as having received at least one test in the previous 2 years. Factors associated with mammography were studied using a logistic regression model. In the three autonomous communities (totalling 11 provinces) with programmes, the percentage of women receiving the test was 41.1% in Castille-Leon, 41.7% in Castille-La Mancha and 87.6% in Navarre (mean: 55.4%). The programmes began in 1990 in Navarre and between 1992 and 1993 in the other two communities. The most important factors affecting mammography use in the multivariate analysis were: intention to have a mammogram [odds ratio (OR) = 5.52; 95% confidence interval (CI) = 3.17-9.63]; not rejecting the test for fear of cancer diagnosis (OR = 4.23; 95% CI = 1.64-10.9); and physician recommendation of the test (OR = 3.43; 95% CI = 1.88-6.24). In conclusion, although the more established screening programmes have higher mammography use than those more recently implemented, programmes alone may not guarantee that women receive the test. Women's attitudes about mammography, and the role of the physician, are fundamental factors in the use of mammography.

Adult↗
PubMed2006

Mammography use and factors associated with its use after the introduction of breast cancer screening programmes in Spain.

The aim of this study was to measure the use of mammography and the factors associated with testing among Spanish women, after the introduction of screening programmes in Spain. We conducted a cross-sectional population survey of a representative sample of women aged 40-70 (2409 women). Data collection took place in October 2000, using a questionnaire addressing the dependent variable (mammography use) and the independent variables (socio-demographic and socio-health factors, and women's knowledge and attitudes). Mammography use was defined as having received at least one screening test in the previous 2 years. Data analysis consisted of univariate and multivariate analyses. 48.1% (95% confidence interval (CI) 46.0-50.2) of women had received screening mammography. The main factors associated with testing were: mammography invitation from the screening programme (odds ratio (OR) 4.81; 95% CI 3.85-6.01); gynaecologist visit (OR 4.32; 95% CI 3.45-5.41); and intention to have a mammogram (OR 2.94; 95% CI 2.00-4.32). Other test-related factors were: not rejecting test for discomfort or fear of cancer; mammography perceived as necessary; age 56-65; upper/upper-middle socio-economic status. In conclusion, after the introduction of screening programmes, almost half of Spanish women aged 40-70 had received mammography. Invitation to screening, gynaecologist visit and women's attitudes are the main reasons for undergoing testing. Women over 65 years of age and/or those in a lower socio-economic level warrant special attention.

Adult↗
PubMed2001

Screening mammography for frail older women: what are the burdens?

OBJECTIVE: The potential benefits and harms of screening mammography in frail older women are unknown. Therefore, we studied the outcomes of a screening mammography policy that was instituted in a population of community-living nursing home-eligible women as a result of requirements of state auditors. We focused on the potential burdens that may be experienced. METHODS: Between January 1995 and December 1997, we identified 216 consecutive women who underwent screening mammography after enrolling in a program designed to provide comprehensive care to nursing home-eligible patients who wished to stay at home. Mammograms were performed at 4 radiology centers. From computerized medical records, we tracked each woman through September 1999 for performance and results of mammography, additional breast imaging and biopsies, documentation of psychological reactions to screening, as well as vital status. Mean follow-up was 2.6 years. RESULTS: The mean age of the 216 women was 81 years. Sixty-three percent were Asian, 91% were dependent in at least 1 activity of daily living, 49% had cognitive impairment, and 11% died within 2 years. Thirty-eight women (18%) had abnormal mammograms requiring further work-up. Of these women, 6 refused work-up, 28 were found to have false-positive mammograms after further evaluation, 1 was diagnosed with ductal carcinoma in situ (DCIS), and 3 were diagnosed with local breast cancer. The woman diagnosed with DCIS and 1 woman diagnosed with breast cancer were classified as not having benefited, because screening identified clinically insignificant disease that would not have caused symptoms in the women's lifetimes, since these women died of unrelated causes within 2 years of diagnosis. Therefore, 36 women (17%; 95% confidence interval [CI], 12 to 22) experienced burden from screening mammography (28 underwent work-up for false-positive mammograms, 6 refused further work-up of an abnormal mammogram, and 2 had clinically insignificant cancers identified and treated). Forty-two percent of these women had chart-documented pain or psychological distress as a result of screening. Two women (0.9%; 95% CI, 0 to 2) may have received benefit from screening mammography. CONCLUSION: We conclude that screening mammography in frail older women frequently necessitates work-up that does not result in benefit, raising questions about policies that use the rate of screening mammograms as an indicator of the quality of care in this population. Encouraging individualized decisions may be more appropriate and may allow screening to be targeted to older women for whom the potential benefit outweighs the potential burdens.

Aged↗
PubMed2004

Disparities in screening mammography. Current status, interventions and implications.

OBJECTIVE: This paper describes trends in screening mammography utilization over the past decade and assesses the remaining disparities in mammography use among medically underserved women. We also describe the barriers to mammography and report effective interventions to enhance utilization. DESIGN: We reviewed medline and other databases as well as relevant bibliographies. MAIN RESULTS: The United States has dramatically improved its use of screening mammography over the past decade, with increased rates observed in every demographic group. Disparities in screening mammography are decreasing among medically underserved populations but still persist among racial/ethnic minorities and low-income women. Additionally, uninsured women and those with no usual care have the lowest rates of reported mammogram use. However, despite apparent increases in mammogram utilization, there is growing evidence that limitations in the national survey databases lead to overestimations of mammogram use, particularly among low-income racial and ethnic minorities. CONCLUSIONS: The United States may be farther from its national goals of screening mammography, particularly among underserved women, than current data suggests. We should continue to support those interventions that increase mammography use among the medically underserved by addressing the barriers such as cost, language and acculturation limitations, deficits in knowledge and cultural beliefs, literacy and health system barriers such as insurance and having a source regular of medical care. Addressing disparities in the diagnostic and cancer treatment process should also be a priority in order to affect significant change in health outcomes among the underserved.

Age Factors↗
PubMed1997

Acceptability of mobile mammography among community-dwelling older women.

OBJECTIVE: To test the acceptability of mobile mammography among community-dwelling older women and to identify factors predictive of mobile mammography acceptance. DESIGN: Case series. SETTING: Twelve community meal sites sponsored by the City of Los Angeles Area on Aging. PARTICIPANTS: Two hundred fifty-five volunteers aged 60 to 84 years who attended community meal sites. INTERVENTION: On-site mammography offered to women who had not had a mammogram within the last year. MEASUREMENTS: Mammography acceptance rates, reasons for accepting or declining the mammogram, and breast cancer knowledge, beliefs, and intentions. MAIN RESULTS: One hundred seven of the 255 (42%) women were ineligible because they had received mammograms within the last year. Of the 148 women eligible, 57% accepted the mammograms and 43% declined; moreover, 20 of the 42 (48%) women who had not had a mammogram within the last 5 years or who never had a mammogram also accepted on-site mammography in the mobile van. Variables identified as predictive of mammogram acceptance included Asian American status, not being an HMO member, being married, a reported willingness to accept a screening mammogram if recommended by a physician, and previous mammogram screening history. CONCLUSION: Mobile mammography is acceptable to many older community-dwelling women. Although mobile mammography does not eliminate all barriers that inhibit a woman from receiving a mammogram, it may substantially increase screening for some groups.

Activities of Daily Living↗