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Persons using assistive technology might not be able to fully access information in this file. For assistance, please send e-mail to: mmwrq@cdc.gov. Type 508 Accommodation and the title of the report in the subject line of e-mail. Self-Reported Use of Mammography Among Women Aged greater than or equal to 40 Years -- United States, 1989 and 1995In 1997, breast cancer will be diagnosed in an estimated 180,200 women, and 43,900 women will die from the disease (1). Early detection combined with timely and appropriate treatment can alter the progress of and reduce mortality from this disease (2). Effective screening procedures are available to detect breast cancer in its early stages. However, the benefits of breast cancer screening to reduce mortality in the population can be achieved only if screening guidelines are followed and a large proportion of women receive screening examinations regularly. To estimate the state-specific proportions of women aged greater than or equal to 40 years who reported receiving a mammogram during the preceding 2 years, CDC analyzed data from the Behavioral Risk Factor Surveillance System (BRFSS) for 1989 and 1995. This report presents the findings, which indicate that, from 1989 to 1995, the percentage of women aged greater than or equal to 40 years who reported receiving a mammogram during the preceding 2 years increased in all 39 states in the survey. In 1989 and in 1995, a total of 39 states * participated in BRFSS. Using a multistage sampling design and a random-digit-dialed telephone survey, each state conducted monthly telephone interviews of a random sample of its noninstitutionalized adult (aged greater than or equal to 18 years) population to provide state-specific estimates of risk factors and the use of preventive services (3). Annual data are weighted to the age, sex, and race distribution of each state's adult population using the most current census or inter-censal estimates. Three BRFSS questions focused on mammography use and were asked only of female respondents aged greater than or equal to 40 years. Each respondent was asked, "Have you ever had a mammogram?" If the respondent answered "yes" to that question, she was asked, "How long has it been since your last mammogram?" and "Was it part of a routine checkup, because of a breast problem other than cancer, or because you had already had breast cancer?" In this analysis, estimates are age-adjusted to the age distribution of women in the 1989 BRFSS sample for participating states. From 1989 to 1995, the overall age-adjusted proportion of women aged greater than or equal to 40 years who reported having had a mammogram during the preceding 2 years increased in each of the 39 participating states (Table_1). The age-adjusted proportion varied widely among the states, from 43.8%-65.2% in 1989 to 63.0%-79.7% in 1995. The median age-adjusted proportion was 53.3% in 1989 and 69.5% in 1995. During this period, the state-specific relative percentage increase ranged from 9% in Minnesota (which, in 1989, already had a relatively high proportion of women who reported having had their most recent mammogram during the preceding 2 years) to approximately 45% in West Virginia and New York. Reported by: Epidemiology and Statistics Br, Div of Cancer Prevention and Control; Health Care and Aging Br, Div of Adult and Community Health (proposed), National Center for Chronic Disease Prevention and Health Promotion, CDC. Editorial NoteEditorial Note: Mammography is the primary procedure for breast cancer screening. The U.S. Preventive Services Task Force recommends a screening mammogram every 1-2 years for women aged 50-69 years (2). In addition, physicians can recommend that high-risk women aged less than 50 years receive a screening mammogram. The National Cancer Institute's 1997 mammography guidelines recommend screening mammograms every 1-2 years for women aged greater than or equal to 40 years if they are at average risk for breast cancer (4). Recently revised American Cancer Society guidelines recommend annual mammography for women aged greater than or equal to 40 years (5). The findings in this report indicate that, from 1989 to 1995, the percentage of women aged greater than or equal to 40 years who reported having had a mammogram during the preceding 2 years increased in all 39 states participating in BRFSS. This finding is consistent with previous studies that indicated increasing reported use of screening mammograms. For example, based on data from the National Health Interview surveys, of women aged greater than or equal to 40 years in 1987, 29% reported having had a mammogram during the preceding 2 years; in 1994, the proportion increased to 61% (6). Similarly, the proportion of women who reported receiving breast cancer screening consistent with American Cancer Society guidelines increased from 31% in 1990 to 47% in 1995 (7). The findings in this report are subject to at least four limitations. First, only 39 states participated in both the 1989 and 1995 BRFSSs; therefore, the results may not be generalizable to the total U.S. population of women aged greater than or equal to 40 years. Second, the telephone survey excluded women living in households without a telephone. Although only 5% of U.S. households are without telephones, the proportion of persons without telephones varies by geographic region, and the characteristics of households with and without telephones are different (8). Thus, the differences observed in this survey may not reflect trends for women without telephones. Third, self-reported mammography use may not be consistent with reports of mammography use from other sources such as medical and imaging-center records (9). Finally, because approximately 15%-20% of contacted households did not respond and respondents may be different from nonrespondents, the precision of the estimates in this report may be reduced. Regular breast cancer screening can reduce the annual rate of breast cancer deaths in the United States; the estimated potential reduction ranges from 19% to 30% for women aged 50-74 years (2). Federal initiatives, such as CDC's National Breast and Cervical Cancer Early Detection Program (NBCCEDP) and Medicare, encourage breast cancer screening by paying for mammograms for women eligible to participate in these programs (10). Since 1991, Medicare has provided insurance coverage for bi-annual mammograms. NBCCEDP provides states, U.S. territories, and programs serving American Indians/Alaskan Natives with resources to provide screening, follow-up, and referral services to medically underserved women. NBCCEDP outreach efforts are aimed at older women, women with low incomes, uninsured or underinsured women, and women of racial/ethnic minority groups. Initiatives to encourage women to receive an initial screening for breast cancer are essential and should emphasize rescreening. References
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| Erratum: Vol. 46, No. 40
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| In the report, "Self-Reported Use of Mammography Among Women
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| Aged greater than or equal to 40 Years -- United States, 1989 and
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| 1995," on page 939, the "All women" line in Table 1 should be
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| deleted.
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TABLE 1. Unadjusted and adjusted* percentage of women aged >=40 years who reported having had a mammogram during the 2 years
preceding the interview, by state -- United States, Behavioral Risk Factor Surveillance System (BRFSS), 1989 and 1995 +
========================================================================================================================================
1989 1995
--------------------------------------------------------- ------------------------------------------------------------
Undadjusted Adjusted Unadjusted Adjusted
--------------- -------------- -------------- ------------------
State & Sample size % (SE@) % (SE) Sample size % (SE) % (SE)
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All women 20,511 54.3 (0.6) 54.3 (0.6) 31,394 67.0 (0.4) 70.3 (0.4)
Alabama 590 49.2 (2.2) 49.1 (2.2) 630 64.5 (2.1) 63.8 (2.1)
Arizona 455 52.2 (2.6) 52.3 (2.5) 731 71.4 (2.5) 71.2 (2.4)
California 632 57.1 (2.4) 57.9 (2.4) 1,221 74.5 (1.7) 75.3 (1.7)
Connecticut 437 63.0 (2.6) 62.7 (2.6) 625 74.8 (2.0) 74.6 (2.0)
Florida 588 53.1 (2.2) 52.7 (2.3) 1,241 74.4 (1.4) 74.0 (1.4)
Georgia 480 53.3 (2.5) 53.3 (2.5) 712 71.0 (1.9) 70.4 (1.9)
Hawaii 504 60.2 (2.5) 58.6 (2.4) 691 75.3 (2.1) 75.5 (2.1)
Idaho 597 49.8 (2.3) 50.0 (2.3) 957 63.4 (1.7) 63.9 (1.7)
Illinois 590 51.1 (2.3) 51.6 (2.3) 1,023 69.9 (1.6) 70.4 (1.6)
Indiana 720 46.7 (2.1) 46.6 (2.0) 855 64.0 (1.8) 64.6 (1.7)
Iowa 460 48.3 (2.6) 48.4 (2.6) 1,324 75.0 (1.2) 75.4 (1.1)
Kentucky 652 50.4 (2.1) 50.1 (2.1) 927 63.3 (1.7) 63.6 (1.7)
Maine 393 55.0 (2.7) 55.7 (2.6) 459 70.0 (2.4) 71.7 (2.3)
Maryland 553 60.4 (2.2) 59.5 (2.1) 1,739 75.0 (1.2) 75.4 (1.1)
Massachusetts 356 64.2 (3.0) 64.5 (3.0) 585 78.9 (1.8) 79.7 (1.8)
Michigan 718 63.9 (2.0) 63.8 (1.9) 835 77.4 (1.5) 77.5 (1.5)
Minnesota 1,013 63.6 (1.6) 64.0 (1.6) 1,280 67.7 (1.4) 69.9 (1.4)
Missouri 519 48.3 (2.4) 49.7 (2.4) 580 66.9 (2.2) 66.4 (2.2)
Montana 407 49.8 (2.7) 49.9 (2.7) 424 65.0 (2.5) 65.2 (2.5)
Nebraska 467 42.7 (2.5) 43.8 (2.5) 669 61.9 (2.1) 63.0 (2.1)
New Hampshire 412 62.4 (2.6) 61.8 (2.7) 494 72.1 (2.2) 72.5 (2.1)
New Mexico 365 56.9 (2.9) 56.5 (2.9) 434 68.6 (2.7) 68.7 (2.6)
New York 435 51.5 (2.9) 51.4 (2.8) 828 73.6 (1.8) 74.4 (1.7)
North Carolina 614 52.9 (2.4) 52.6 (2.4) 1,208 65.8 (1.5) 65.8 (1.5)
North Dakota 532 59.1 (2.3) 59.4 (2.4) 647 68.0 (2.0) 69.5 (2.0)
Ohio 482 53.8 (2.5) 53.8 (2.4) 491 68.3 (2.4) 68.1 (2.3)
Oklahoma 430 59.0 (2.6) 49.8 (2.6) 646 64.5 (2.2) 64.3 (2.2)
Oregon 608 57.3 (2.2) 57.2 (2.2) 1,021 68.8 (1.6) 71.1 (1.5)
Pennsylvania 618 52.6 (2.2) 53.4 (2.1) 1,251 62.9 (1.6) 63.1 (1.6)
Rhode Island 630 64.5 (2.2) 65.2 (2.2) 565 71.5 (2.2) 71.7 (2.1)
South Carolina 634 50.4 (2.2) 50.4 (2.1) 712 71.0 (1.9) 71.1 (1.9)
South Dakota 555 47.2 (2.3) 47.3 (2.3) 635 61.7 (2.2) 63.1 (2.2)
Tennessee 837 48.2 (1.9) 48.4 (1.8) 698 67.2 (1.9) 67.3 (1.9)
Texas 454 54.3 (2.6) 54.4 (2.6) 544 64.8 (2.3) 65.6 (2.2)
Utah 524 51.0 (2.5) 50.9 (2.5) 937 62.9 (2.2) 63.4 (2.1)
Virginia 406 58.4 (2.9) 57.0 (2.8) 585 72.4 (2.2) 72.5 (2.2)
Washington 474 56.5 (2.4) 57.2 (2.4) 1,072 70.1 (1.5) 71.3 (1.5)
West Virginia 637 45.8 (2.2) 45.2 (2.2) 1,007 65.0 (1.7) 65.3 (1.7)
Wisconsin 363 56.3 (2.8) 57.0 (2.8) 676 63.1 (2.3) 63.5 (2.3)
Range (42.7-64.5) (43.8-65.2) (61.7-78.9) (63.0-79.7)
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* Adjusted to the 1989 BRFSS age distribution for women.
+ Denominator includes all female respondents aged >=40 years.
& A total of 39 states participated in BRFSS in 1989 and in 1995.
@ Standard error.
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