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PubMed1989

Effects of age, education, and physician advice on utilization of screening mammography.

We investigated the utilization of mammography as a screening test for breast cancer in a middle-income Connecticut suburban community of 30,000 people. The sampling frame was community-dwelling women aged 30 years and over who had telephones. Random digit telephone survey methods were used to identify a sample of 470 eligible subjects. Of those eligible to be included, 350 or 74.4% completed the interview. Analysis of data from the 171 respondents aged 50 years or greater indicated that women aged 65-80 years had a significantly lower rate of screening mammography than did women aged 50-64 years (means 2 = 6.6, P = .01). When further analysis was done to take into account the effects of education and of income on these rates, the association of age with mammography utilization was no longer statistically significant. Among women who recalled their physician advising a mammogram, 88% had had one performed. Among women who could not recall their physician advising a mammogram, 7% had had one. The impact of physician advice was statistically significant (means 2 = 110.3, P less than .001). Physicians recommended screening mammography less for patients with low level of education (means 2 = 21.6, P less than .001), low income (X2 = 7.8, df = 2, P = .02) and greater age (means 2 = 14.2, P = .003). We conclude that utilization of screening mammography in the community studied is related more strongly to education and to income than to age. The bivariate association of mammography utilization with age may be attributable to a cohort effect, rather than an age effect.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1992

The risk factors of age and family history and their relationship to screening mammography utilization.

OBJECTIVE: To study the association of two well known risk factors for breast cancer and the association of knowledge of those risk factors with mammography utilization. DESIGN: Cross sectional: two independent random telephone surveys. SETTING: Two Northeastern metropolitan communities surveyed in 1987 and in 1989. PARTICIPANTS: Women without breast cancer who spoke English and who were between 45 and 75 years of age. MAIN OUTCOME MEASURES: The two risk factors measured were a family history of breast cancer and being 65 or older. Participants were surveyed about their knowledge of risk factors, presence of risk factors, selected beliefs, attitudes, reinforcing factors and mammography use. Results were analyzed for women 50-75. RESULTS: There was a substantial increase in mammography use over the 2-year period. Having a positive family history or being older is not associated with increased mammography utilization. Knowledge that family history and/or age are risks is associated with increased utilization. However, knowledge of risk factors is not associated with having those risks. Older women have lower utilization than younger women regardless of their knowledge of age as a risk. Increased physician recommendation is associated with increased utilization. CONCLUSION: Since knowing that a factor is a risk and having a physician recommend mammography are each associated with increased use, we conclude that the primary care physicians' role in increasing mammography utilization is critical.

Age Factors↗
PubMed2000

Mammography use among women as a function of age and patient involvement in decision-making.

OBJECTIVE: To assess the extent to which self-reported patient involvement in decision-making for initiation of mammography differs with age. DESIGN: Data from the 1992 National Health Interview Survey (NHIS) Cancer Control Supplement were evaluated. Prevalences were weighted and variances were adjusted using SUDAAN software to account for the complex, multistage sampling probability design of the NHIS. Logistic regression was used to evaluate the relative likelihood of self-reported involvement in the decision to have a mammogram within the preceding year as a function of age and other covariates. PARTICIPANTS: Mammography use was assessed among 3,863 NHIS female respondents 40 years of age or older. The analysis of decision-making was restricted to the subgroup of 1,064 women who reported a screening mammogram within the preceding year and who provided information on the other relevant variables. MEASUREMENTS AND MAIN RESULTS: The probability of reported mammography use within the preceding year declines among older groups of interviewees. Among women with a mammogram in the preceding year, the weighted percentage of women reporting active involvement in the decision (patient decision or decided jointly with a physician) declines from 51% among women 40 to 45 years of age to 19% among those aged 75 years or older. The adjusted odds ratio comparing the likelihood of participating in the decision to have a mammogram for the oldest women, compared with the youngest, was 0.31 (95% confidence interval 0.15 to 0.61). CONCLUSIONS: Older women are substantially less likely than younger women to report active involvement in the mammography decision-making process. Increased use of screening mammography among older women will require greater promotion by physicians. Other interventions, such as directed educational efforts, may also be needed to increase mammography demand among older women.

Adult↗
PubMed2004

Office systems and their influence on mammography use in rural and urban primary care.

CONTEXT: Breast cancer screening rates are lower in rural communities. Although studies have addressed barriers to mammography for rural residents, physician practice barriers have received less attention. PURPOSE: Controlled clinical trials have shown that the use of office reminder systems in primary care practices is related to increased clinical care rates. Therefore, we compared office systems use in primary care practices located in rural and urban communities and assessed the impact of these systems on rural-urban differences in mammography utilization. METHODS: We identified female Kansas Medicare beneficiaries aged 65 to 79 from Medicare claims data (N = 24,030) and determined which beneficiaries received a mammogram between April 1, 1999, and March 31, 2001. We linked beneficiaries to their primary care providers and obtained surveys from 180 primary care practices on their use of office reminder systems. FINDINGS: Mammography rates ranged from 20% to 92% (mean = 65%) among the 180 practices. Flowsheets with a mammography prompt were used by 33% of the practices, 38% utilized nonphysician staff to identify women due for mammograms, and 15% used computerized reminder systems. Urban practices used flowsheets more often than rural practices (44% versus 16%, P < 0.001). A multivariable regression model demonstrated higher mammography rates in urban practices, group practices, and practices using mammography flowsheets. CONCLUSIONS: Despite success in randomized controlled trials, reminder systems are not used often by primary care providers and are used even less often in rural compared to urban practices. Consistent implementation may be a major barrier to the successful adaptation of flowsheets by primary care offices.

Aged↗
PubMed2001

Misconceptions about efficacy of mammography screening: a public health dilemma.

OBJECTIVE: This study assessed accuracy of women's opinions about reduction in mortality from breast cancer attributable to mammography screening. DESIGN: Cross sectional survey. SETTING: General population of Geneva, Switzerland. PARTICIPANTS: 895 randomly selected women aged 40 to 80 years, free of breast cancer. RESULTS: Women estimated the proportion of deaths from breast cancer that regular mammography screening prevents in women over age 50. Only 19.3% of the respondents assessed screening efficacy realistically (that is, reduction by about one fourth); 52.0% overestimated efficacy; 26.0% "didn't know", and 2.6% stated that screening prevents no death. Women who believed mammography screening to be effective had more positive attitudes toward screening (higher scores of pros and lower scores of cons) and were more likely to plan to have a mammogram (both p<0.001). Lack of opinion about the benefit of mammography screening was more common among women who had not consulted a gynaecologist recently (p=0.02) nor had had a mammogram during the past two years (p=0.009), who had no opinion about their risk of breast cancer (p<0.001), and who were 70 to 80 years old (p=0.04). Compared with women who provided realistic estimates of screening efficacy, those who overestimated efficacy believed to be at higher risk of breast cancer than other women (p=0.04) and were more likely to be Swiss nationals (p=0.001). CONCLUSIONS: Most women overestimated and many were uninformed about the efficacy of mammography screening. Therefore, few women were able to take truly informed decisions about screening mammography.

Adult↗
PubMed2001

Quality assurance for screening mammography: an international comparison.

STUDY OBJECTIVE: In 1998, the International Breast Cancer Screening Network (IBSN) sponsored an assessment of quality assurance policies and practices to define their scope for population-based screening mammography programmes across IBSN countries. DESIGN: Analysis of data from a survey designed to assess multiple elements of screening programme quality assurance, including organisation of quality assurance activities, mechanisms for site visits and accreditation, requirements for quality control and data systems, and inclusion of treatment, follow up, and programme evaluation in screening mammography quality assurance activities. PARTICIPANTS AND SETTING: IBSN representatives in 23 countries completed a comprehensive questionnaire between May and December 1998. MAIN RESULTS: Completed questionnaires were obtained from all 23 countries. Responses indicated that countries vary in their approaches to implementing quality assurance, although all monitor components of structure, process, and outcome. Nearly all have in place laws, surveillance mechanisms, or standards for quality assurance. In all countries, quality assurance activities extend beyond the screening mammography examination. CONCLUSIONS: The assessment has enhanced understanding of the organisation of screening mammography programmes across countries, as well as the comparability of screening mammography data. All countries have established mechanisms for assuring the quality of screening mammography in population-based programmes, although these mechanisms vary across countries.

Breast Neoplasms↗
PubMed1998

Mammography: influence of departmental practice and women's characteristics on patient satisfaction: comparison of six departments in Norway.

OBJECTIVE: To investigate how departmental practice and women's characteristics are related to low patient satisfaction with mammography. DESIGN: Survey of patients by means of self administered questionnaires before and after mammography. PATIENTS: 488 women (89% of those invited), aged 23-86 years, at six departments. MAIN OUTCOME MEASURES: Low level of satisfaction measured on psychometric scales of physical pain, psychological distress, staff punctuality and technical skills, information provided, and physical surroundings. RESULTS: Satisfaction varied by department on the scales for pain, punctuality, information, and surroundings. After adjustment for women's characteristics an attributable risk of negative outcome by department was identified on the scales for pain, distress, punctuality, information, and surroundings. Adjusted odds ratio (ORs) ranged from 0.3 (95% confidence interval (95% CI) 1.2 to 6.0) on the pain scale, to 6.0 (2.9 to 12.3) on the punctuality scale. After adjustment for confounding variables, higher risk of dissatisfaction was associated with age < 50, nervousness about mammography, expected pain, lack of knowledge about mammography, and distrust in mammography (adjusted OR (95% CI) ranged from 1.6 (1.0 to 2.7) to 3.7 (2.0 to 7.3)). CONCLUSION: Departmental practices differed for breast compression, information, punctuality, and facilities and were associated with a low level of satisfaction irrespective of patient characteristics. Women's lack of knowledge about mammography and distrust in the procedure were confirmed as risk factors for dissatisfaction. All these factors might be helped by training the staff, improving facilities, and informing the women.

Adult↗
PubMed2002

Comparison of the performance of screening mammography, physical examination, and breast US and evaluation of factors that influence them: an analysis of 27,825 patient evaluations.

PURPOSE: To (a) determine the performance of screening mammography, ultrasonography (US), and physical examination (PE); (b) analyze the influence of age, hormonal status, and breast density; (c) compare the size and stage of tumors detected with each modality; and (d) determine which modality or combination of modalities optimize cancer detection. MATERIALS AND METHODS: A total of 11,130 asymptomatic women underwent 27,825 screening sessions, (mammography and subsequent PE). Women with dense breasts subsequently underwent screening US. Abnormalities were deemed positive if biopsy findings revealed malignancy and negative if findings from biopsy or all screening examinations were negative. RESULTS: In 221 women, 246 cancers were found. Sensitivity, specificity, negative and positive predictive values, and accuracy of mammography were 77.6%, 98.8%, 99.8%, 35.8%, and 98.6%, respectively; those of PE, 27.6%, 99.4%, 99.4%, 28.9%, and 98.8%, respectively; and those of US, 75.3%, 96.8%, 99.7%, 20.5%, and 96.6%, respectively. Screening breast US increased the number of women diagnosed with nonpalpable invasive cancers by 42% (30 of 71). Mammographic sensitivity declined significantly with increasing breast density (P <.01) (48% for the densest breasts) and in younger women with dense breasts (P =.02); the effects were independent. Mammography and US together had significantly higher sensitivity (97%) than did mammography and PE together (74%) (P <.001). Tumors detected at mammography and/or US were significantly smaller (P =.01) and of lower stage (P =.01) than those detected at PE. CONCLUSION: Mammographic sensitivity for breast cancer declines significantly with increasing breast density and is independently higher in older women with dense breasts. Addition of screening US significantly increases detection of small cancers and depicts significantly more cancers and at smaller size and lower stage than does PE, which detects independently extremely few cancers. Hormonal status has no significant effect on effectiveness of screening independent of breast density.

Age Factors↗
PubMed2003

Contrast-enhanced digital mammography: initial clinical experience.

PURPOSE: To investigate the potential of using intravenous contrast material with full-field digital mammography to facilitate the detection and characterization of lesions in the breast. MATERIALS AND METHODS: Twenty-two women scheduled for biopsy because they were suspected of having abnormalities at breast imaging underwent imaging with contrast material-enhanced digital mammography. Six sequential images of the affected breast were obtained, with a contrast agent injected intravenously between the time the first and second images were obtained. Image processing included registration and logarithmic subtraction. Lesions were evaluated for the presence, morphology, and kinetics of enhancement. Lesion type, size, and pathologic findings were correlated with the findings at contrast-enhanced digital mammography. RESULTS: At contrast-enhanced digital mammography, enhancement was observed in eight of 10 patients with biopsy-proved cancers. In one case of ductal carcinoma in situ and one case of invasive ductal carcinoma, enhancement was not observed. No enhancement was seen in seven of 12 cases in which lesions were suspected of being malignant at initial imaging but were benign. Morphology generally correlated with the pathologic diagnosis. The kinetics of lesion enhancement showed similarity to that seen with gadolinium-enhanced magnetic resonance imaging but was not consistent. CONCLUSION: The results of this preliminary study suggest that contrast-enhanced digital mammography potentially may be useful in identification of lesions in the mammographically dense breast. Further investigation of contrast-enhanced digital mammography as a diagnostic tool for breast cancer is warranted.

Adult↗
PubMed1990

Mammography in the eighties.

Mammography has experienced the greatest change of any existing radiologic examination in recent years. In 1985, as a part of the Nationwide Evaluation of X-Ray Trends (NEXT) program, a national survey was conducted of a statistically selected sample (n = 232) of facilities performing mammography examinations in the United States. By 1988, the number of mammography facilities in the United States had increased to over 6,400, an increase of over 60% from the 1985 level. To assess the consequence of this expansion as well as the impact of recent technological and other significant developments on mammography, a NEXT survey of mammography facilities was repeated in 1988 (n = 226). Screen-film mammography accounted for 83% of the facilities surveyed in 1988, and dedicated equipment dominated screen-film systems (99%). There was a 26% increase in the overall mean phantom image score, over 45% increase in the use of grids, and 10% increase in mean glandular dose for systems using grids.

Ambulatory Care Facilities↗
PubMed1994

Screening mammography in women aged 40-49 years: analysis of cost-effectiveness.

PURPOSE: To evaluate the cost-effectiveness of screening mammography in women 40-49 years old. MATERIALS AND METHODS: A Markov model compared two hypothetical groups; one underwent screening mammography and the other, observation without mammography. Variables tested included frequency of mammography, reduction in breast cancer mortality, and cost-effectiveness by age group. Results were expressed as marginal cost per year of life saved. RESULTS: If the estimated mortality reduction from mammographic screening was 15% or greater, the marginal cost per year of life saved was comparable to that of other generally accepted medical procedures. Annual screening with an assumed 30% reduction in mortality had a cost-effectiveness similar to that of biennial screening with a 20% reduction. Screening mammography was less cost-effective in the 40-49-year-old age group than in women aged 50-79 years but more cost-effective than in those aged 80-84 years. CONCLUSION: Although the parameters for screening mammography in women aged 40-49 years are not known with certainty, the results of this analysis may help establish priorities for utilization of medical resources.

Adult↗
PubMed1995

Normalized average glandular dose in magnification mammography.

PURPOSE: To evaluate the normalized average glandular dose (the average glandular dose per unit entrance skin exposure) in magnification mammography. MATERIALS AND METHODS: Photon transport in the breast was simulated by using Monte Carlo methods. A semielliptical cylinder containing glandular and adipose tissue was used to simulate the breast. Measured mammography spectra for a molybdenum target-molybdenum filter unit were utilized. The normalized average glandular dose was calculated as a function of half-value layer, tube voltage, breast thickness, and breast composition for typical magnification geometries. RESULTS: The normalized average glandular dose in magnification mammography is 7%-25% lower than that with the contact (nonmagnification) technique because of the effects of partial irradiation, smaller field size, and greater percentage depth dose gradient at the reduced source-to-skin distance. CONCLUSION: The normalized average glandular dose in magnification mammography is lower than that in contact mammography. The average glandular dose in magnification mammography, however, is still substantially greater due to the two to three times greater entrance skin exposure.

Female↗
PubMed1997

Screening mammography: effect of national guidelines on current physician practice.

PURPOSE: To evaluate the effect of national breast cancer screening guidelines on current physician attitudes toward and practice of screening mammography. MATERIALS AND METHODS: Questionnaire responses from 278 physicians were analyzed. The questionnaire had four sections: general information on physician practice and experience, current use of breast cancer screening, perceptions of screening mammography, and physician awareness of and response to the controversy in breast cancer screening. RESULTS: In women aged 40-49 years, 144 (52%) of 278 physicians performed annual clinical breast examination and screening mammography every 2 years; 57 (21%) favored annual mammography and clinical breast examination. In women aged 50 years and older, 232 (83%) physicians screened patients annually with clinical breast examination and mammography. Two hundred seventeen (78%) physicians were aware of the recommended changes in screening guidelines; 54 (19%) were not aware of the changes. Of those aware of the changes, 56 (26%) changed to the new guidelines, 150 (69%) did not change, and six (3%) modified their practice somewhat. CONCLUSION: Physician practice as regards screening mammography is influenced by national guidelines.

Adult↗
PubMed1997

Screening mammography: sensitivity and specificity in relation to hormone replacement therapy.

PURPOSE: To evaluate the possible effects of hormone replacement therapy (HRT) on the sensitivity and specificity of screening mammography. MATERIALS AND METHODS: Twenty thousand women aged 50 years or older were interviewed about use of HRT during the second round of screening mammography; of these, 3,126 were currently using, 2,158 had previously used, and 14,716 had never used HRT. Women with breasts known to be composed of predominantly fatty tissue were examined with one-view mammography; otherwise, two-view mammography was used. RESULTS: The sensitivity of screening mammography was 96% (95% confidence interval, 81.0%, 99.1%) in women currently using, 92% (61.5%, 99.8%) in women who had previously used, and 91% (85.7%, 96.8%) in women who had never used HRT. The specificity was 94% (93.3%, 95.0%), 95% (93.7%, 95.6%), and 95% (94.8%, 95.5%), respectively. There was a slight decrease in specificity with duration of treatment for the current-user group. However, specificity in women treated with continuous combined estradiol-progestin for less than 3 years (90%) was lower than that in women treated with other regimens (95%, P = .037). CONCLUSION: There was no decrease in the sensitivity of screening mammography in women currently using HRT, but there was a marginal decrease in specificity varying with the HRT regimen and duration of treatment.

Estrogen Replacement Therapy↗
PubMed1999

Mammography in the 1990s: the United States and Canada.

PURPOSE: To evaluate trends in mammography quality before and after the implementation of the Mammography Quality Standards Act (MQSA) of 1992 and to compare technical data collected in the United States with corresponding data obtained from the first survey of mammography facilities conducted in 1994-1995 in Canada. MATERIALS AND METHODS: Data from MQSA inspections conducted in 1995-1997 were analyzed and compared with survey data on U.S. mammography facilities acquired before the MQSA. Technical indicators of mammography quality such as radiation dose phantom image score, film processing, and darkroom fog were analyzed. RESULTS: In the United States, phantom image scores, along with other technical measures of performance such as film processing, darkroom fog, and x-ray beam quality, have improved continuously since 1985. The U.S. mean glandular dose has increased to 1.6 mGy compared with the Canadian dose of 1.1 mGy. The mean total phantom image score with artifact subtraction was 11.1 in Canada in 1994-1995 and 11.8 in the U.S. in 1997. CONCLUSION: Mammography quality is better today than it has been at any other time in the United States. With the exception of radiation dose. Canadian technical measures of performance are comparable to measures before MQSA in the United States.

Canada↗
PubMedDate not supplied

Motivating mammography adherence in elderly Latinas: a test of three mathematical models of decision making.

Many elderly Latinas do not have mammography every one to two years as recommended by cancer organizations. To elucidate the causal factors underlying this behavior, 52 Latinas, aged 65 and over, were asked to judge the likelihood of having yearly mammography in 79 different scenarios constructed from factor levels of cost, perceived risk, and the source of a recommendation (none, a recognized cancer organization, a doctor), assuming a convenient mammography facility. A configural-weight-averaging model, with different parameter values for the 30 adherers (women who reported having had mammography at least twice in the preceding four years) and the 22 non-adherers, gave a good fit to the data and did well in predicting reported mammography adherence (r = 0.85). According to this model, offering free mammography would not induce non-adherers to adhere; they would require a recommendation, and value a doctor's as highly as that of a recognized cancer organization, but reported never having received one from either source. All 52 women reported never receiving risk information from any source. These results have direct educational and dissemination implications for cancer organizations.

Aged↗
PubMed2004

Moving in between mammography: screening decisions of American Indian women in Vermont.

Breast cancer is a leading cause of cancer death among American Indian women, with mammography screening rates below the national average for this population. A grounded theory study, conducted with Vermont American Indian women, explicated factors that influence mammography decision making. The authors examined mammography decision making across the breast cancer screening continuum: women with a history of consistent annual mammograms, women who were under users or nonusers of mammography, and women who were breast cancer survivors. The generated theory, Moving in Between Mammography, describes the decision-making process and factors that influenced women's participation in routine mammography screening. Specific influencing factors addressed include Connecting to Nativeness, Taking Care of Self, Financing Health Care, and (Mis)Trusting the Health Care System. Implications and directions for future research are addressed.

Breast Neoplasms↗
PubMed2003

Promoting repeat mammography use: insights from a systematic needs assessment.

This article describes the process and outcome of a needs assessment conducted to guide the development of interventions to increase repeat mammography use among participants in a federally funded cancer screening program. Health behavior theory and data from a phone survey are used to uncover key barriers to repeat mammography use and to identify fruitful intervention approaches for modifying them. Estimates of (a) compliance with mammography guidelines, (b) readiness to adopt regular mammography use, (c) the most common reasons for not being rescreened, and (d) population attributable risks associated with various predictors of repeat mammography use are presented and, with guidance from the transtheoretical model of behavior change, used to make inferences about the type of intervention strategies most appropriate for promoting repeat mammography use in this population.

Aged↗