Breast cancer screening initiation after turning 40 years of age within the PROSPR consortium.
Although United States clinical guidelines differ, the earliest recommended age for average risk breast cancer screening is 40 years. Little is known about factors influencing screening initiation.



We conducted a cohort study within the National Cancer Institute-funded Population-based Research Optimizing Screening through Personalized Regimens (PROSPR) consortium. We identified 3413 women on their 40th birthday in primary care networks at Geisel School of Medicine at Dartmouth (DH) and Brigham and Women's Hospital (BWH) during 2011-2013 with no prior breast imaging or breast cancer. Cumulative incidence curves and Cox modeling were used to determine time from the 40th birthday to first breast cancer screening, cohort exit, or 42nd birthday. We calculated hazards ratios and 95 % confidence intervals from multivariable Cox proportional hazards models.



Breast cancer screening cumulative incidence by the 42nd birthday was 62.9 % (BWH) and 39.8 % (DH). Factors associated with screening initiation were: a primary care visit within a year (HR 4.99, 95 % CI 4.23-5.89), an increasing number of primary care visits within a year (p for trend <0.0001), ZIP code of residence annual median household income ≤$52,000 (HR 0.79, 95 % CI 0.68-0.92), and health insurance type (Medicaid HR 0.72, 95 % CI 0.58-0.88; Medicare HR 0.55, 95 % CI 0.39-0.77; uninsured HR 0.37, 95 % CI 0.25-0.57).



Breast cancer screening uptake after the 40th birthday varies by health system, primary care visits, median household income, and health insurance type, suggesting the need for further exploration. Future research should evaluate screening performance metrics after initiation and consider cumulative benefits and risks associated with breast cancer screening over time.
Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, M3-A306, PO Box 19024, Seattle, WA, 98109, USA. ebeaber@fredhutch.org.
Elisabeth F
EF
Beaber
The Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, 1 Medical Center Drive, Lebanon, NH, 03756, USA.
Anna N A
AN
Tosteson
Department of General Internal Medicine and Primary Care, Brigham and Women's Hospital, 1620 Tremont Street, Boston, MA, 02120, USA.
Jennifer S
JS
Haas
The Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, 1 Medical Center Drive, Lebanon, NH, 03756, USA.|Departments of Biomedical Data Science and Epidemiology, Geisel School of Medicine at Dartmouth, 1 Medical Center Drive, Lebanon, NH, 03756, USA.
Tracy
T
Onega
Department of Surgery and the University of Vermont Cancer Center, University of Vermont, 1 S. Prospect Street, Burlington, VT, 05401, USA.
Brian L
BL
Sprague
Department of Pathology and the University of Vermont Cancer Center, University of Vermont, 1 S. Prospect Street, Burlington, VT, 05401, USA.
Donald L
DL
Weaver
Department of General Internal Medicine, Massachusetts General Hospital, 50 Staniford Street, Boston, MA, 02114, USA.
Anne Marie
AM
McCarthy
Department of Family Medicine and Community Health and the Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
Chyke A
CA
Doubeni
Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S Los Robles, Pasadena, CA, 91101, USA.
Virginia P
VP
Quinn
Department of Clinical Science, Simmons Comprehensive Cancer Center, University of Texas Southwestern, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA.
Celette Sugg
CS
Skinner
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
Ann G
AG
Zauber
Cancer Research and Biostatistics, 1730 Minor Ave, Seattle, WA, 98101, USA.
William E
WE
Barlow
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000453:epidemiology*; D015331:Cohort Studies; D015897:Comorbidity; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D015994:Incidence; D008403:Mass Screening; D008875:Middle Aged; D011159:Population Surveillance; D016016:Proportional Hazards Models; D012307:Risk Factors; D017751:Safety Management
Breast neoplasms; Early detection of cancer; Mammography; Mass screening; Prevention & control; Primary health care
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