VCU Study Shows More Women Getting Mammograms

By Sathya Achia Abraham

Women over the age of 40 are most likely to have mammograms if they have a doctor, health insurance and access to preventive health services, according to a Virginia Commonwealth University study published in the current issue of the American Journal of Health Promotion.

Researchers examined data from the 2002 Behavioral Risk Factors Surveillance Survey. Of the approximately 93,000 women aged 40 and older who participated in the telephone survey, 76 percent reported having a mammogram within the past two years.

These findings, reported in the July-August 2005 issue of the journal, may help guide practitioners in their efforts to ensure that all women receive appropriate mammography screening services.

Furthermore, the findings exceed the 70 percent mammography utilization targets set by Healthy People 2010 – a national health promotion and disease prevention initiative. Healthy People 2010 is intended to improve quality and years of life while eliminating health disparities.

“In 1998, only 67 percent of women were having mammograms,” said Kirsten Barrett, Ph.D., a senior research associate at the VCU Survey and Evaluation Research Laboratory, and lead author of the study. “Our findings indicate that mammography use is on the rise for women 40 years and older, however, there are certain subgroups that continue to lag behind.

“Those subgroups include women without health insurance, women who do not have a primary care physician and women who lack basic preventive care such as pap smears and breast exams,” said Barrett.

Researchers assessed the relationship between mammography utilization and a number of demographic and health factors, including education level, income, age, access to care, insurance coverage and use of other preventive health services.

With regard to health insurance, 79 percent of insured women received a mammogram within the past two years as compared to 53 percent of those without insurance. Further, 80 percent of women who reported having a personal doctor received a mammogram within the past two years; among women without a personal doctor, only 48 percent had a mammogram within the past two years.

“Clearly, women in these subgroups need targeted outreach and education efforts to facilitate access and utilization of mammography services,” Barrett said.

“The increase in the number of women getting a mammogram may be attributed to a number of factors including health promotion and education programs and physician recommendations for mammography,” said Jeff Legg, an assistant professor and interim chair in the Department of Radiation Sciences at VCU and co-author of the paper.

Legg said that the strongest predictor of mammography use is physician recommendation. “If a woman’s physician recommends she have a mammogram, more than likely she is going to do it.”

According to Legg, the quest to improve mammography use has been going on for years. Today, there are more health promotion programs in place targeting women with lower use of preventive health services, as well as those lacking health coverage and a health care provider compared with 10 years ago.

Initiatives to develop materials and public service announcements to reach non-English speaking groups are under way. Also, programs that reach to other resources in the community have been shown to be successful, said Legg. For example, lay health advisors in communities in the South and Southwest have been trained to become advocates for women’s health care use and to discuss with women the importance of having a mammogram or pap smear, said Legg.

In addition, many states now have low-cost mammography for women who may lack health insurance or cannot afford it – which greatly helps eliminate financial barriers.

“At this time, mammography remains the best early detection technology to help screen for breast cancer,” he said. “All the efforts at state, local and federal levels appear to be working, but we still need to maintain vigilance.”