title: Dissemination of periodic mammography and patterns of use, by birth cohort, in Catalonia (Spain).
abstract: BACKGROUND
  In Catalonia (Spain) breast cancer mortality has declined since the beginning of the 1990 s. The dissemination of early detection by mammography and the introduction of adjuvant treatments are among the possible causes of this decrease, and both were almost coincident in time. Thus, understanding how these procedures were incorporated into use in the general population and in women diagnosed with breast cancer is very important for assessing their contribution to the reduction in breast cancer mortality. In this work we have modeled the dissemination of periodic mammography and described repeat mammography behavior in Catalonia from 1975 to 2006.
  
  
  METHODS
  Cross-sectional data from three Catalan Health Surveys for the calendar years 1994, 2002 and 2006 was used. The dissemination of mammography by birth cohort was modeled using a mixed effects model and repeat mammography behavior was described by age and survey year.
  
  
  RESULTS
  For women born from 1938 to 1952, mammography clearly had a period effect, meaning that they started to have periodic mammograms at the same calendar years but at different ages. The age at which approximately 50% of the women were receiving periodic mammograms went from 57.8 years of age for women born in 1938-1942 to 37.3 years of age for women born in 1963-1967. Women in all age groups experienced an increase in periodic mammography use over time, although women in the 50-69 age group have experienced the highest increase. Currently, the target population of the Catalan Breast Cancer Screening Program, 50-69 years of age, is the group that self-reports the highest utilization of periodic mammograms, followed by the 40-49 age group. A higher proportion of women of all age groups have annual mammograms rather than biennial or irregular ones.
  
  
  CONCLUSIONS
  Mammography in Catalonia became more widely implemented during the 1990 s. We estimated when cohorts initiated periodic mammograms and how frequently women are receiving them. These two pieces of information will be entered into a cost-effectiveness model of early detection in Catalonia.
authors.affiliation: Biomedical Research Institut of Lleida (IRBLLEIDA), Lleida, Catalonia, Spain. montse.rue@cmb.udl.cat
authors.forename: Montserrat
authors.initials: M
authors.lastname: Rue
authors.forename: Misericordia
authors.initials: M
authors.lastname: Carles
authors.forename: Ester
authors.initials: E
authors.lastname: Vilaprinyo
authors.forename: Montserrat
authors.initials: M
authors.lastname: Martinez-Alonso
authors.forename: Josep-Alfons
authors.initials: JA
authors.lastname: Espinas
authors.forename: Roger
authors.initials: R
authors.lastname: Pla
authors.forename: Pilar
authors.initials: P
authors.lastname: Brugulat
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data*; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data; D008875:Middle Aged; D013030:Spain