Mammography usage in a community-based sample of older women

Abstract

Recent data indicate that less than 39% of women aged 50 and older are compliant with the age-specific guidelines for mammography. Cost has often been identified as the greatest barrier to mammography utilization. This study examined adherence to mammography screening guidelines as well as the motivators and barriers to mammography usage among a community-based sample of 1,134 middle- and upper-middle-class, relatively well-educated women aged 55 and older, all of whom had access to health care. A mailed questionnaire using open-ended (unleading) questions was used to assess motivators and barriers to regular mammography. Women were classified as never-users (11.6%), sporadic-users (38.5%), and annual-users (49.9%). Never users were significantly older than women in the other two groups. Annual-users were significantly more likely to be current estrogen users, report a history of reproductive cancer, and rate their health as excellent or good. Major motivators for mammography included the recommendation of a health care provider, familiarity with mammography via the media, and belief in its efficacy. This cohort of women who had the advantage of health care access nevertheless reported low annual mammography rates and identified several barriers to seeking the procedure. Important barriers to mammography included fear of pain, fear of radiation, and lack of perceived need. After adjustment for age, estrogen use, cancer history, and personal health, never-users and sporadic users reported significantly fewer motivators and more barriers than annual-users. Results indicate the importance of health education and outreach for older women in every socioeconomic strata.