Advertisement

Utilization of Screening Mammography in Women Before 50: Cross-Sectional Survey Results from the National Health Interview Survey

Published:August 11, 2022DOI:https://doi.org/10.1016/j.acra.2022.07.014

      Objective

      While the American College of Radiology recommends annual screening mammography starting at age 40 years, the US Preventive Services Task Force (USPSTF) recommends that screening mammography in women younger than age 50 years should involve shared- decision making (SDM) between clinicians and patients, considering benefits and potential harms in younger women. Using a nationally representative cross-sectional survey, we aimed to evaluate patient-reported reasons and predictors of screening mammography utilization in this age group.

      Methods

      Respondents aged 40-49 years from the 2018 National Health Interview Survey (NHIS) without a history of breast cancer were included (response rate 64%). Participants reported sociodemographic variables and reasons they did not engage in mammography screening within the last two years. Multiple variable logistic regression analyses were performed to evaluate the association between sociodemographic characteristics and patient-reported screening mammography use, accounting for complex survey sampling design elements.

      Results

      1,948 women between the ages of 40-49 years were included. Of this group, (758/1948) 46.6% reported receiving a screening mammogram within the last year, and 1196/1948 (61.4%) reported receiving a screening mammogram within the last two years. The most common reasons for not undergoing screening included: “No reason/never thought about it” 744/1948 (38.2%), “Put it off” 343/1948 (17.6%), “Didn't need it” 331/1948 (16.9%), “Doctor didn't order it” 162/1948 (8.3%), and “I'm too young” 63/1948 (5.3%). Multiple variable analyses demonstrated that lack of health insurance was the strongest predictor of mammography non-engagement (p< 0.001).

      Conclusion

      Deficits in shared- decision-making in women younger than 50 years related to mammography utilization exist. Radiologists may be key in addressing this issue among ambulatory care providers and patients, educating about the benefits and harms of screening younger women, particularly in racial/ethnic minorities and uninsured patients, who experience additional barriers to care and SDM discussions.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Academic Radiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Peart O.
        Breast intervention and breast cancer treatment options.
        Radiol Technol. 2015; 86 (quiz 559-562): 535M-558M
        • DeSantis CE
        • Ma J
        • Gaudet MM
        • et al.
        Breast cancer statistics, 2019.
        CA Cancer J Clin. 2019; 69: 438-451https://doi.org/10.3322/caac.21583
        • Khrouf S
        • Letaief Ksontini F
        • Ayadi M
        • Belhaj Ali Rais H
        • Mezlini A
        Breast cancer screening: a dividing controversy.
        Tunis Med. 2020; 98: 22-34
        • Siu AL.
        Screening for Breast Cancer: U.S. Preventive Services Task Force Recommendation Statement.
        Ann Intern Med. 2016; 164: 279-296https://doi.org/10.7326/m15-2886
        • Müller E
        • Hahlweg P
        • Scholl I.
        What do stakeholders need to implement shared decision making in routine cancer care? A qualitative needs assessment.
        Acta Oncologica. 2016; 55: 1484-1491https://doi.org/10.1080/0284186X.2016.1227087
        • von Elm E
        • Altman DG
        • Egger M
        • Pocock SJ
        • Gøtzsche PC
        • Vandenbroucke JP.
        The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies.
        Int J Surg. 2014; 12: 1495-1499https://doi.org/10.1016/j.ijsu.2014.07.013
        • Statistics NCfH
        National Health Interview Survey. 2018;
        • Elwyn G
        • Laitner S
        • Coulter A
        • Walker E
        • Watson P
        • Thomson R.
        Implementing shared decision making in the NHS.
        Bmj. 2010; 341: c5146https://doi.org/10.1136/bmj.c5146
        • Abrams EM
        • Shaker M
        • Oppenheimer J
        • Davis RS
        • Bukstein DA
        • Greenhawt M.
        The Challenges and Opportunities for Shared Decision Making Highlighted by COVID-19.
        J Allergy Clin Immunol Pract. 2020; 8 (e2471): 2474-2480https://doi.org/10.1016/j.jaip.2020.07.003
        • Grol R
        • Dalhuijsen J
        • Thomas S
        • Veld C
        • Rutten G
        • Mokkink H.
        Attributes of clinical guidelines that influence use of guidelines in general practice: observational study.
        Bmj. 1998; 317: 858-861https://doi.org/10.1136/bmj.317.7162.858
        • Burgers JS
        • Grol RP
        • Zaat JO
        • Spies TH
        • van der Bij AK
        • Mokkink HG.
        Characteristics of effective clinical guidelines for general practice.
        Br J Gen Pract. 2003; 53: 15-19
        • Hughes TM
        • Merath K
        • Chen Q
        • et al.
        Association of shared decision-making on patient-reported health outcomes and healthcare utilization.
        Am J Surg. 2018; 216: 7-12https://doi.org/10.1016/j.amjsurg.2018.01.011
        • Coulter A.
        Partnerships with patients: the pros and cons of shared clinical decision-making.
        J Health Serv Res Policy. 1997; 2: 112-121https://doi.org/10.1177/135581969700200209
        • Henderson LM
        • O'Meara ES
        • Haas JS
        • et al.
        The Role of Social Determinants of Health in Self-Reported Access to Health Care Among Women Undergoing Screening Mammography.
        J Womens Health (Larchmt). 2020; 29: 1437-1446https://doi.org/10.1089/jwh.2019.8267
        • Durand MA
        • Carpenter L
        • Dolan H
        • et al.
        Do interventions designed to support shared decision-making reduce health inequalities? A systematic review and meta-analysis.
        PLoS One. 2014; 9: e94670https://doi.org/10.1371/journal.pone.0094670
        • White A
        • Thompson TD
        • White MC
        • et al.
        Cancer Screening Test Use - United States, 2015.
        MMWR Morb Mortal Wkly Rep. 2017; 66: 201-206https://doi.org/10.15585/mmwr.mm6608a1
        • Ryu SY
        • Crespi CM
        • Maxwell AE.
        What factors explain disparities in mammography rates among Asian-American immigrant women? A population-based study in California.
        Womens Health Issues. 2013; 23: e403-e410https://doi.org/10.1016/j.whi.2013.08.005
        • Stapleton SM
        • Oseni TO
        • Bababekov YJ
        • Hung Y-C
        • Chang DC.
        Race/Ethnicity and Age Distribution of Breast Cancer Diagnosis in the United States.
        JAMA Surgery. 2018; 153 (Accessed 8/8/2021): 594-595https://doi.org/10.1001/jamasurg.2018.0035
        • Miller BC
        • Bowers JM
        • Payne JB
        • Moyer A.
        Barriers to mammography screening among racial and ethnic minority women.
        Soc Sci Med. 2019; 239112494https://doi.org/10.1016/j.socscimed.2019.112494
        • Gigerenzer G.
        Breast cancer screening pamphlets mislead women.
        Bmj. 2014; 348: g2636https://doi.org/10.1136/bmj.g2636
        • Yu L
        • Yang S
        • Zhang C
        • et al.
        Decision aids for breast cancer screening in women approximately 50 years of age: A systematic review and meta-analysis of randomised controlled trials.
        J Clin Nurs. 2021; https://doi.org/10.1111/jocn.16112
        • Cooper K
        • Heilbrun ME
        • Gilyard S
        • Vey BL
        • Kadom N.
        Shared Decision Making: Radiology's Role and Opportunities.
        AJR Am J Roentgenol. 2020; 214: W62-w66https://doi.org/10.2214/ajr.19.21590
        • Padilla Garrido N
        • Aguado Correa F
        • Bayo Lozano E
        • Bayo Calero J
        • Ortega Moreno M.
        [Physicians' awareness and assessment of shared decision making in oncology practice.].
        Rev Esp Salud Publica. 2019; : 93