Factors influencing adherence to guidelines for screening mammography among women aged 40 years and older

Ethn Dis. Fall 2003;13(4):477-84.


Objective: To explore patterns of adherence to guidelines for screening mammography among participants in the Colorado Mammography Project (CMAP) surveillance database.

Methods: An algorithm was developed to assess factors associated with adherence to mammography screening guidelines.

Results: Of the 27,778 women ranging from 40-90 years of age included in the analysis, 41.4% were adherent with mammography screening guidelines. According to the model tested in this study, race/ethnicity (Black vs White, OR=0.76, 95% CI=0.64-0.91); educational attainment (high school vs <high school, OR=1.10, 95% CI=1.04-1.18, college graduate vs <high school OR=1.33, 95% CI=1.25-1.42); insurance status, (any coverage vs no coverage, OR=1.62, 95% CI=1.25-2.12); and community economic status as defined by median income by zip code of residence (15,000 dollars-24,999 dollars vs <15,000 dollars, OR=0.84, 95% CI=0.76-0.94, >55,000 dollars vs <15,000 dollars, OR 1.14, 95% CI=1.03-1.26) were statistically significant predictors of adherence to guidelines. A significant interaction between age and family history of breast cancer (BC) was also found. Younger females with a family history of BC were less likely to be adherent than their counterparts without a family history (OR=0.93, 95% CI=0.90-0.96). In general, elderly women were more likely to be adherent compared with the youngest group in this cohort (OR=1.21, 95% CI=1.11-1.33). Inclusion or exclusion of women aged 70 years and older did not change the outcome of the analysis.

Conclusion: Adherence with screening mammography guidelines was found to be associated with women's personal characteristics including race/ethnicity, age, and family history of BC. In addition, socioeconomic status, as measured by educational level and community economic status, are important predictors of adherence. Efforts to increase adherence may need to be specific to race/ethnic group and age, but the effect of age is mediated by family history of BC and vice versa.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Algorithms
  • Attitude to Health*
  • Breast Neoplasms / epidemiology
  • Breast Neoplasms / prevention & control*
  • Female
  • Humans
  • Mammography
  • Mass Screening
  • Middle Aged
  • Odds Ratio
  • Ohio / epidemiology
  • Patient Compliance
  • Population Surveillance
  • Practice Guidelines as Topic
  • Socioeconomic Factors