title: Mammography utilization in Canadian women aged 50 to 69: identification of factors that predict initiation and adherence.
abstract: OBJECTIVE
  To identify factors that predict initiation of mammography and adherence with biennial screening among Canadian women aged 50-69 years.
  
  
  METHODS
  Using data from a longitudinal panel of Canadian women interviewed in the National Population Health Survey (NPHS) in 1994/95 and 2 and 4 years later, we estimated the relative risks (RR) of mammography initiation and adherence according to socio-demographic, health and lifestyle characteristics.
  
  
  RESULTS
  Among 505 women with no history of mammography use at baseline, 23.0% and 41.4% initiated mammography by 2 and 4 years, respectively. Urban residence (RR = 2.85) was most strongly associated with initiation by 2 years; younger age (50-54) and lower education also predicted initiation by 2 years. Younger age, birthplace outside Canada, and having a recent (< 2 years) blood pressure check were associated with initiation by 4 years. Among 873 women reporting a recent (< 2 years) mammogram at baseline, 88.7% also reported a recent mammogram within 2 years while 73.0% reported one at both the 2- and 4-year follow-up. Being a non-smoker was the strongest predictor of maintaining adherence both at the 2- (RR = 1.18) and the 4-year (RR = 1.37) follow-up.
  
  
  CONCLUSIONS
  Previously identified underserved groups of Canadian women (e.g., those with lower educational levels or born outside of Canada) were most likely to initiate mammography. Approximately 1 in 6 women aged 50 to 69 years remained never-users during follow-up, and fewer than half reported recent mammograms at all three survey cycles, suggesting the need to reinforce regular screening participation.
authors.affiliation: Health Canada, Centre for Chronic Disease Prevention and Control, Ottawa, ON.
authors.forename: Christina M
authors.initials: CM
authors.lastname: Bancej
authors.forename: Colleen J
authors.initials: CJ
authors.lastname: Maxwell
authors.forename: Jay
authors.initials: J
authors.lastname: Onysko
authors.forename: Michael
authors.initials: M
authors.lastname: Eliasziw
mesh_terms: D000367:Age Factors; D000368:Aged; D002170:Canada; D005260:Female; D015438:Health Behavior; D019538:Health Care Surveys; D006801:Humans; D007407:Interviews as Topic; D008327:Mammography / Q000706:statistics & numerical data*; D008403:Mass Screening; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D014600:Utilization Review