title: Mammography diffusion and trends in late-stage breast cancer: evaluating outcomes in a population.
abstract: The purpose of this study was to assess mammography diffusion in a population offered an organized breast cancer screening program, using intervals of 1-3 years, and to evaluate its effect on the late-stage cancer (tumors > or = 3 cm2) rates compared to rates in the surrounding community. We measured "ever-use" of mammography (1986-1992) among women enrollees of a consumer-controlled health care organization (n > or = 60,000/year; ages > or = 40), Group Health Cooperative of Puget Sound (GHC). Among these same women and the surrounding community (n = > or = 745,000/year), we measured late-stage cancer rates. Using unconditional logistic regression, we compared annual rates of ever-use among GHC women ages 40-49 and > or = 50 (1986-1992) and late-stage breast cancer (1983/84-1991/92) among all women. Among all GHC women ages 40 to 49, and 50 years of age and older, 67.4 and 82.8%, respectively, ever-used mammography by 1992. By 1992, approximately one-third of the mammograms among GHC women occurred in each of the three previous years. The rate of late-stage tumors declined significantly in the GHC and non-GHC populations among women 50 years of age and older (P < 0.001) but not among women ages 40 to 49. In conclusion, implementing a system of automated reminders was not sufficient to maximize mammography use in a population. Reductions in late-stage disease occurred among women ages > or = 50, even when regular" was not synonymous with "annual."
authors.affiliation: Department of Preventive Care, Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle, Washington 98101-1448, USA.
authors.forename: S H
authors.initials: SH
authors.lastname: Taplin
authors.forename: M T
authors.initials: MT
authors.lastname: Mandelson
authors.forename: C
authors.initials: C
authors.lastname: Anderman
authors.forename: E
authors.initials: E
authors.lastname: White
authors.forename: R S
authors.initials: RS
authors.lastname: Thompson
authors.forename: D
authors.initials: D
authors.lastname: Timlin
authors.forename: E H
authors.initials: EH
authors.lastname: Wagner
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000473:pathology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008327:Mammography / Q000706:statistics & numerical data*; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D009367:Neoplasm Staging; D010043:Outcome and Process Assessment, Health Care; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012307:Risk Factors; D014861:Washington / Q000453:epidemiology