Abstract P1-11-05: Womens' opinion on when to start screening mammography and reasons for not undergoing screening
Authors: Komenaka Ian K , Heberer Meredith , Nodora Jesse , Hsu Chiu-Hsieh , Winton Lisa , Bouton Marcia , Martinez Maria Elena 
Published: May 2015

Background: In late 2009 significant controversy arose when some screening recommendations were changed to advocate screening mammography starting at age 50 rather than the long standing recommendation of starting at age 40 years. More recently some studies have called into question the benefit of screening mammography. The current study was performed to evaluate patients’ opinion on when women should start screening mammography and reasons for not undergoing screening.

Methods: Maricopa Medical Center is the safety net hospital in Phoenix, Arizona. 1,157 consecutive patients were seen at the Breast Clinic from May 2013 to May 2014. Sociodemographic variables were collected including health literacy assessment using the Newest Vital Sign (NVS) validated screening instrument. Patients were asked when they felt women should start screening mammography. In addition, in women at least 40 years of age, if they did not undergo screening mammography, they were asked for the primary reason for not undergoing screening. Differences in patient characteristics were evaluated based on a Fisher’s exact test for categorical variables and one-way ANOVA for continuous variables.

Results: Thirteen of the 1,157 consecutive patients were male and excluded. The average age of the 1,144 consecutive female patients was 45 years. Most patients were Hispanic, underinsured, and had limited health literacy. Overall use of screening mammography was poor at only 24%. 402 women (35%) felt that age 40 years was the most appropriate time to start screening. Only 30 women (3%) felt that age 50 years was the most appropriate age. More women, 470 (41%), chose an age younger than age 40 to start screening. More than half (55%) of these women who chose an age 50 years or younger, however, did not undergo screening because they felt they had "no problems" or "didn’t know" they should get a mammogram despite choosing an age to start that was below their current age. Only 187 women (32%) cited cost as the reason for not undergoing screening. Other reasons for not undergoing screening were: physician did not recommend and other medical problems/forgot/too busy. Few patients (4%) cited problems with mammograms for not undergoing screening and none cited concerns about false positives. Multivariate analysis showed that patients with adequate health literacy and insurance were more likely to use screening mammography than patients who were uninsured or had limited health literacy. Family history of breast cancer was not associated with use of screening mammography.

Conclusions: Use of screening mammography was poor in this underinsured population. Most women felt that screening mammography should start at age 40 years or younger. More than half of women who did not undergo screening did not do so because they had "no problems" or "didn't know" they should. Although many women feel that screening should start at age 40, most women in this population do not understand the concepts of screening and early detection. Interventions to increase use of screening mammography should focus of the concept of screening as well as the age.

Citation Format: Ian K Komenaka, Meredith Heberer, Jesse Nodora, Chiu-Hsieh Hsu, Lisa Winton, Marcia Bouton, Maria Elena Martinez. Womens' opinion on when to start screening mammography and reasons for not undergoing screening [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-11-05.