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
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Article info
Publication history
Published online: August 11, 2022
Accepted:
July 15,
2022
Received in revised form:
June 30,
2022
Received:
May 11,
2022
Identification
Copyright
© 2022 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.
