Who has regular mammograms? Effects of knowledge, beliefs, socioeconomic status, and health-related factors

doi:10.1016/j.ypmed.2004.11.016

Preventive Medicine

Volume 41, Issue 1, July 2005, Pages 312-320

https://doi.org/10.1016/j.ypmed.2004.11.016 Get rights and content

Abstract

Background.

Breast cancer accounts for the largest proportion of female cancer deaths and new cases in New South Wales (NSW). Biennial screening is recommended for women aged 50–69 years. Objectives were to (1) identify associations between beliefs and knowledge about breast cancer and mammography, socioeconomic (SES) indicators, and health-related factors, and having a mammogram (a) ever and (b) within the last 2 years; and (2) describe utilization of mammography.

Methods.

2974 women aged 50–69 years selected from the BreastScreen NSW (BSNSW) database and the NSW Electoral Roll were administered a structured telephone survey. Associations were assessed using weighted Chi squares and age-adjusted odds ratios from logistic regression with 95% confidence intervals.

Results.

Strong positive associations were found between age, married/de facto relationship, knowledge about and belief in the benefits of screening, indicators of health status and service utilization, and whether women had had a mammogram or had one within the recommended period. SES was weakly associated with regularity of mammography. Most respondents (97.4%) reported having had at least one mammogram.

Conclusions.

Specific aspects of knowledge and beliefs about mammograms and individual health-related factors would be important components of initiatives to encourage initial and repeat screening in the targeted age group.

Introduction

Breast cancer is responsible for the largest proportion of female deaths from any form of cancer in Australia [1] and has accounted for approximately 16% of all cancer-related deaths in recent years [2], [3]. While breast cancer mortality rates showed a downward trend in the 1990s [2], incidence rates, partly influenced by population screening [4], increased by 19% in the period from 1990 to 2000 [3]. In New South Wales (NSW), breast cancer is responsible for the largest proportion of new cancers that are reported [3], making up 29% of female cancers in 2000 [5]. These figures suggest that about 1 in 11 females would develop breast cancer by the age of 75 years [3].

Population-based studies have shown that mammography can be effective in early detection [6] and consequently significantly reduce breast cancer mortality [7], [8]. Mammograms without direct charge can be obtained from BSNSW by women who are 40 years or older or from private providers (paid for via Medicare, the government-funded universal health insurance scheme if the purpose is identified as diagnostic). BSNSW is a government-funded organization that recruits and offers women aged 50 to 69 years two yearly breast screening. Its aim is to reduce morbidity and mortality attributable to breast cancer [9] and the way to achieve this is to promote screening at recommended intervals. Identifying and understanding barriers to the recruitment of women into a regular screening program is therefore a key concern.

Although comparison of studies is difficult because of differences in access and availability of breast screening in different health systems, some predictors of mammographic screening have been consistent across studies. Two consistent findings are the positive associations of breast screening with high income [10], [11] and having a ‘usual’ or ‘regular’ source of medical care [12], [13]. Conflicting results have been reported regarding the effects of education [14], [15], age [14], [16], marital status [14], [17], and the presence of co-morbidities [17], [18].

Utilizing a BSNSW database, the present cross-sectional study aimed to examine how SES, beliefs and knowledge of women regarding breast cancer and mammography, health status, and health service utilization are associated with self-report of ever having a mammogram and mammography at regular intervals. An earlier report from this survey used BSNSW-defined mammography attendance to examine predictors of regular screening with BSNSW [19].

Section snippets

Participants

With the approval of the NSW Department of Health Ethics Committee, women were selected from the BSNSW database (those who had had at least one mammogram at BSNSW) and from the NSW Electoral Roll (those who had never attended BSNSW for a mammogram). The sampling frame utilized BSNSW data (information on actual screening behavior) to provide a relatively unique data set enabling a better understanding of possible predictors of utilization of mammography.

The BSNSW database consists of women aged

Results

Inability to contact potential respondents by phone and insufficient English proficiency were the most common factors contributing to the 49% participation rate detailed elsewhere [23]. Of the 4381 eligible women telephoned to request their participation in the survey, 3106 completed the survey, resulting in a response rate of 71%. Two participants were excluded from the analyses because their screening status on the BSNSW register categorized them as ‘current screeners’ but they reported that

Discussion

We examined four mammography attendance status groups, defined according to self-reported utilization of mammography, comparing ever with never and recent with overdue mammography.

With the exception of an inverse association between the lowest-income category and mammography use, the present findings did not support previous reports of strong associations between SES indicators and mammography utilization [15], [27]. The relatively limited effect of SES indicators on mammography utilization,

Conclusion

A lack of knowledge and inaccurate beliefs about mammographic screening and poor health service utilization must be addressed if more women in their early 50s are to reap the benefits of early detection [53]. Women need to be reminded that mammography is an effective screening procedure and mammograms cannot be replaced by breast examination [54]. Recent debates on the effectiveness of mammograms [55] and population-based [56] versus high-risk individual [57] screening, necessitate reassurance

Acknowledgments

This study was funded in part by a grant from the Commonwealth Department of Health and Ageing.

We thank the following people for their assistance with the survey: Leendert Moerkerken, Rajah Supramaniam, Teresa Tomczyk, and Michelle Phillips.

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Who has regular mammograms? Effects of knowledge, beliefs, socioeconomic status, and health-related factors

Abstract

Background.

Methods.

Results.

Conclusions.

Introduction

Section snippets

Participants

Results

Discussion

Conclusion

Acknowledgments

Lancet

Am. J. Prev. Med.

Prev. Med.

Prev. Med.

Prev. Med.

Aust. N. Z. J. Public Health

Prev. Med.

Prev. Med.

Prev. Med.

Prev. Med.

Prev. Med.

Aust. J. Public Health

Am. J. Prev. Med.

Am. J. Prev. Med.

Am. J. Prev. Med.

Lancet

BreastScreen Australia: population health division

Mortality and morbidity in Western Sydney Area Health Service: 1990–1998

Cancer in New South Wales: incidence and mortality 2000 featuring projections to 2010 for selected sites: the Cancer Council NSW, 2002: The Cancer Council New South Wales

Estimating risk of breast cancer from population incidence affected by widespread mammographic screening

J. Med. Screen.

Health outcomes information system toolkit, deaths 2000: NSW Department of Health

Mammography use, breast cancer stage at diagnosis, and survival among older women

J. Am. Geriatr. Soc.

The accuracy and effectiveness of routine population screening with mammography, prostate-specific antigen, an prenatal ultrasound: a review of published scientific evidence

Int. J. Technol. Assess. Health Care

Breast and cervical cancer screening in Australia 1996–97

Predictors of mammography use among Canadian women aged 50–69: findings from the 1996/97 National Population Health Survey

Can. Med. Assoc. J.

Prospective study of predictors of attendance for breast screening in inner London

J. Epidemiol. Community Health

Breast cancer screening in the United States and Canada, 1994: socioeconomic gradients persist

Am. J. Public Health

Breast cancer detection: knowledge, attitudes, and behaviors of women from Pennsylvania

Oncol. Nurs. Forum

Chronic disease as a barrier to breast and cervical cancer screening

J. Gen. Intern. Med.