Which women aren't getting mammograms and why? (United States).
OBJECTIVE
This study investigates why women who reported no recent mammogram did not get the test.


METHODS
Using data from the 2000 National Health Interview Survey (NHIS), we examine correlates of mammography use among women 40 years and older (n = 10,212), with particular focus on the 30% (n = 3,188) who reported no recent mammogram. Non-screening is examined in the context of two important correlates of mammography use-access to health care and a physician's recommendation to get a mammogram.


RESULTS
In total, 80% of non-screeners who reported having access to healthcare did not receive a recommendation for a mammogram. Women age 65 years and older were more likely than younger women to report not receiving a recommendation (OR 1.77, 95% CI 1.25-2.50). For women who reported having access, non-screening was significantly more likely among younger women (40-49), those with less education, incomes less than 20,000 dollars, residence outside Metropolitan Statistical Areas (MSAs) and no family history of breast cancer. Among women with access problems, those who had not visited a primary care provider in the past year were much more likely to be non-screeners (80%) compared with those who had seen a provider (46%). Among women with access, those who reported put it off as the main reason for non-screening were significantly more likely to be younger and to be born in the U.S. than women who said that they didn't know they needed a mammogram.


CONCLUSIONS
Most non-screeners report not receiving a physician recommendation for mammography. Although a minority reported access problems, the effect of lacking access on utilization was strong and is accentuated when women without access do not see a doctor. These findings confirm the importance of a mammography recommendation and raise questions concerning whether this information is being conveyed by physicians or heard by patients.
Meissner
Helen I
HI
Applied Cancer Screening Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, 6130 Executive Blvd., EPN 4102 MSC 7331, Bethesda, MD 20892-7331, USA. hm36d@nih.gov
Breen
Nancy
N
Taubman
Michele L
ML
Vernon
Sally W
SW
Graubard
Barry I
BI
D000328:Adult; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000517:prevention & control; D003710:Demography; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008327:Mammography / Q000523:psychology / Q000706:statistics & numerical data*; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data; D010817:Physician-Patient Relations; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014481:United States