Increasing Mammography Utilization: A Controlled Study

• Published in: JNCI : Journal of the National Cancer Institute 1993-01, Vol.85 (2), p.112-120
• Main Authors: Fletcher, Suzanne W., Harris, Russell P., Gonzalez, Jorge J., Degnan, Darrah, Lannin, Donald R., Strecher, Victor J., Pilgrim, Carol, Quade, Dana, Earp, Jo Anne, Clark, Richard L.
• Format: Article
• Language: English
• Subjects: Age Factors; Aged; Biological and medical sciences; Breast cancer; Breast Neoplasms - diagnostic imaging; Breast Neoplasms - prevention & control; Female; Gynecology. Andrology. Obstetrics; Health Knowledge, Attitudes, Practice; Humans; Mammary gland diseases; Mammography; Mammography - statistics & numerical data; Mass Screening; Medical research; Medical sciences; Middle Aged; North Carolina; Rural Population; Socioeconomic Factors; Tumors
• ISSN: 0027-8874; 1460-2105
• DOI: 10.1093/jnci/85.2.112

Background Despite the effectiveness of breast cancer screening for women older than 50 years of age, only about one third of these women in the United States receive annual mammography. Purpose This study was designed to determine if a community-wide intervention could increase use of mammography screening for breast cancer. Secondary end points were determination of changes in women's knowledge and attitudes toward mammography and physicians' self-reported screening practices. Methods We conducted a controlled study from January 1987 through January 1990 in two eastern North Carolina communities—New Hanover County (the experimental community) and Pitt County (the control community). Before development and implementation of the intervention program in New Hanover County and after the program had been in operation for 1 year, 500 women of ages 50–74 years and all primary-care physicians in each community were interviewed by telephone. In these interviews, we determined the use of mammography for breast cancer screening and the knowledge and attitudes about it We also established the number of screening mammograms performed in 1987 and 1989 in each county and reviewed medical records to determine the percentage of women the physicians had referred for mammograms. Results The percentage of women who reported receiving a mammogram in the previous year increased from 35% to 55% in the experimental community and from 30% to 40% in the control community (difference of differences, 10%; P = .03 after adjustment for race, education, age, and having a regular doctor; 95% confidence interval, 1%–18%). Increases were greater in New Hanover County regardless of age, race, income, and education. However, the increase was less for Black women than for White women, both overall and in most demographic subgroups. The total number of mammograms performed increased 89% in the experimental community and 45% in the control community. Women's knowledge about mammography changed little, but the intention to get a mammogram increased 30% in New Hanover County, compared with a 17% increase in Pitt County a statistically significant difference (P