title: Trends in mammography utilization for breast cancer screening in a Middle-Eastern country: Lebanon 2005-2013.
abstract: BACKGROUND
  In Lebanon, annual national breast awareness campaigns were started in 2002 during the international breast month of October to promote the utilization of mammography for women aged ≥ 40. The impact of the campaigns has been assessed periodically since 2003. Results of 2003-2005 campaigns have been published previously.
  
  
  OBJECTIVE
  To measure the prevalence of two behavioral outcomes of interest: ever-use of mammography, and repeat mammography in the previous 12 months among ever-users. The prevalence was described by region and age group. The aim was to document the effectiveness of the program towards reaching a nationally defined goal of 80% screening coverage.
  
  
  METHODS
  The survey's sampling frame was developed incrementally, and since 2005 it has included women aged ≥ 40 from all areas of Lebanon. The sample size has also increased incrementally from 1200 in 2005 to 2400 in 2013. Results have been tabulated biannually and presented as historical trends with regional and demographic variations covering a 9-year period.
  
  
  RESULTS
  In all six consecutive surveys presented here, the mean age of participating women was about 50 years. Year-by-year increases in utilization indicators were detected, with consistent differences in favor of the more urban areas in and around the capital city Beirut and its suburbs (Greater Beirut or GB). By 2013, ever-utilization had reached 43% (41-45) and recent mammography 20% (18-22) nationwide. Utilization was significantly more important in the age group 50-59 compared with the age group 40-49 or ≥ 60. While recent rates have increased nationwide, they have reached a plateau of about 25% in GB and are tending to the same level in other areas.
  
  
  CONCLUSIONS
  While initial progress was slow, it has been accelerating in the last 4-5 years, indicating that the message is being accepted by a larger audience of targeted women at each iteration. However, concern remains that women between 40 and 50 and those >60 are not responding as well as desired to the screening message, for reasons currently under investigation.
authors.affiliation: Faculty of Medicine of the Saint-Joseph University (USJ), Beirut, Lebanon. Electronic address: fadyhaddad.fh@gmail.com.
authors.forename: Fady G
authors.initials: FG
authors.lastname: Haddad
authors.affiliation: Faculty of Medicine of the Saint-Joseph University (USJ), Beirut, Lebanon.
authors.forename: Hampig Raphael
authors.initials: HR
authors.lastname: Kourie
authors.affiliation: Faculty of Medicine of the Saint-Joseph University (USJ), Beirut, Lebanon.
authors.forename: Salim M
authors.initials: SM
authors.lastname: Adib
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology; D055088:Early Detection of Cancer / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007861:Lebanon; D008327:Mammography / Q000706:statistics & numerical data*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Arab; Early detection; Prevention; Research-in-action; Surveys; Women