How many eligible women receive mammograms to detect breast cancer?

Seven of 10 community-dwelling women ages 40 and older had received a recent mammogram as of 2003, compared with only three of 10 in 1987. Among the states in 2004, screening rates ranged from 64 percent to 82 percent.

Percentage of Community-Dwelling Wome n Ages 40 and Older Who Received a Mammogram in the Past Two Years, 1987–2003

Why is this important?

• Breast cancer is the most prevalent non–skin cancer among U.S. women, with more than 200,000 new cases and 40,000 deaths annually (ACS 2005). Breast cancer victims lose 19 years of life on average (Reis et al. 2005).
• Mammography can detect breast cancer at its earliest and most treatable stage, reducing the chance of dying from breast cancer by about 16 percent on average in controlled studies (USPSTF 2002).
• The U.S. Preventive Services Task Force and other medical experts recommend that women have a mammogram every one to two years starting at age 40, although the evidence is strongest for screening in women ages 50 to 69. Older women are likely to benefit from mammography if their life expectancy is not compromised by comorbid illness (USPSTF 2002).

Findings

• From 1987 to 2003, the proportion of community-dwelling women ages 40 and older who had a mammogram in the past two years more than doubled, from 29 percent to 70 percent. However, there was no change from 1999 to 2003 (NCHS 2004, 2005).
• By age group, mammography rates in 2003 were higher among women ages 50 to 74 (75–76%) than among women ages 40 to 49 (64%) or ages 75 and older (61%). The largest increase from 1987 to 2003 occurred among women ages 65 to 74 (48 percentage points) while the smallest increase occurred among women ages 40 to 49 (32 percentage points) (NCHS 2005).
• Thirty-eight states (including the District of Columbia) met the national Healthy People 2010 goal of 70 percent or higher. Screening rates among women ages 40 and older ranged from 64 percent in Idaho to 82 percent in Delaware (NDDC 2006).

Implications

Further progress is needed to meet the national screening goal in every state and to screen the one-quarter to one-third of women who are not being screened but for whom mammography is known to be effective. Moreover, other research shows that many of those who are screened do not consistently obtain mammograms at recommended intervals throughout their lifetimes (Phillips et al. 1998).

Improvement Ideas and Resources

Increases in mammography rates during the 1990s were probably brought about by initiatives such as the National Breast and Cervical Cancer Early Detection Program for medically underserved women, better insurance coverage for cancer screening, quality improvement programs, and public education on this issue. Further improvement might be achieved by:

• Providing tools to help women participate with their physicians in making informed decisions about screening (Phillips et al. 1998; Walter and Covinsky 2001).
• Ensuring access to primary care providers and the availability of mammography facilities with reminder systems (Phillips et al. 1998).
• Improving women's experiences with mammography through supportive care by the mammography technician (Carney et al. 2002).

Measure:

The denominator includes civilian, noninstitutionalized women ages 40 and older (or of specified ages). The numerator includes those in the denominator who reported receiving a mammogram in the past two years (question wording varied slightly across different survey years). National rates were age-adjusted to the 2000 U.S. standard population.

Limitations:

Self-reported data are subject to potential recall bias. Differences in question wording across survey years creates some imprecision in time trends. In particular, rates for 1999, 2000, and 2003 may be "slightly overestimated" compared with rates for years before 1999 because of ambiguity in interpreting responses for a small percentage of participants in the latter three years (NCHS 2005). The data do not indicate the appropriateness of screening for women ages 70 and older based on health status or life expectancy.

Source:

National rates were compiled by the National Center for Health Statistics (NCHS 2005) using data from the National Health Interview Survey, a nationally representative household survey of the civilian, noninstitutionalized population. State rates were compiled by the National Center for Chronic Disease Prevention and Health Promotion (NDDC 2006) using data from the Behavioral Risk Factor Surveillance System, a telephone survey that is representative of the civilian, noninstitutionalized adult population in each state.

References:

* Indicates source of data used in the chart(s).ACS (American Cancer Society). 2005. Cancer Facts and Figures. Atlanta, Ga.: American Cancer Society. Carney, P. A., B. G. Harwood, J. E. Weiss et al. 2002. Factors Associated with Interval Adherence to Mammography Screening in a Population-Based Sample of New Hampshire Women. Cancer 95 (2): 219–27. * NCHS (National Center for Health Statistics). 2005. Health United States, 2005. Hyattsville, Md.: Centers for Disease Control and Prevention. * NDDC (National Center for Chronic Disease Prevention & Health Promotion). 2006. Behavioral Risk Factor Surveillance System. Atlanta, Ga.: Centers for Disease Control and Prevention. Phillips, K. A., K. Kerlikowske, L. C. Baker et al. 1998. Factors Associated with Women's Adherence to Mammography Screening Guidelines. Health Services Research 33 (1): 29–53. Reis, L., M. Eisner, C. Kosary et al. 2005. SEER Cancer Statistics Review, 1975–2002. Bethesda, Md.: National Cancer Institute. USPSTF (U.S. Preventive Services Task Force). 2002. Screening for Breast Cancer: Recommendations and Rationale. Annals of Internal Medicine 137(5 Part 1): 344–6. Walter, L. C., and K. E. Covinsky. 2001. Cancer Screening in Elderly Patients: A Framework for Individualized Decision Making. Journal of the American Medical Association 285 (21): 2750–6.