Factors affecting screening mammography among low-income women: A report from the Southern Community Cohort Study

A100

Introduction. Screening mammography is the most effective, readily available, method for early detection of breast cancer.The U.S. Preventive Services Task Force recommends screening mammography every 1-2 years for average-risk women 40 years and older. The Southern Community Cohort Study (SCCS) provides a unique data source for evaluating cancer screening practices in a large, low-income, predominantly African American population. Using the SCCS data, we estimated the rates of recent mammography use (within the past 2 years), investigated the influence of demographics, socioeconomic status, health insurance coverage, and breast cancer risk factors on recent mammography use by race, and examined perceived barriers to screening mammography among women who never have received a mammogram.
 Methods. Included in the analyses were 27,123 African-American and White women, who were aged 42-79 and enrolled into the SCCS from March 2002 through December 2006. The chi-square test was used to evaluate racial differences in thedistribution of subject characteristics and to examine racial differences in reasons reported for never having had a mammogram. Multivariable logistic regression models were used to estimate odds ratios (ORs) and corresponding 95% confidence intervals (95% CI) for the associations between recent mammography use and variables of interest.
 Results. The results showed that the rate of recent mammography use reported was 72% in the study population, with 73% among African Americans and 68% among Whites. As a whole, age, household annual income, educational attainment, health insurance coverage, family history of breast cancer, age at first live birth, hormone replacement therapy use, and post-menopausal status were positively associated with recent mammography, whereas alcohol consumption of 2 or more drinks/day was negatively associated. Significant associations of recent mammography with postmenopausal status and age at first live birth at older than 30 years were only seen in African-American women; while other associations were similar between African-American and White women. The most common reasons reported by African-American women for not engaging in screening were “doctor has not recommended this test” (26%) and “cost” (21%), followed by “put it off or too busy” (14%), “fear of finding cancer” (10%), “may experience pain or discomfort during this test” (7%), “forgot to do it” (6%), and “embarrassment” (1%). Among White women, the top three reasons reported were “cost” (34%), “doctor has not recommended this test” (22%) and “put it off or too busy” (16%). Less common reasons reported by the White women were “may experience pain or discomfort during this test” (10%), “fear of finding cancer” (6%), “forgot to do it” (3%), and “embarrassment” (3%).
 Conclusions. Our findings suggested that although recent mammography screening rates are high overall, there are subsets of women, such as those with low incomes, without insurance, and with less education, who may benefit from targeted interventions. Characteristics of those women who never have had a mammogram and their perceived barriers to mammography use as identified in this study may provide valuable information for maintaining the progress made and for further improving adherence to the screening guidelines.