Psychosocial Factors and Mammography Use

Abstract

Background and Methods: Although mammography is the most effective modality for detecting early breast cancer and reducing mortality caused by this disease, it is still underutilized. To learn more about the extent to which sociodemographic features; health behaviors; attitudes and beliefs about mammography; and certain psychological traits, such as anxiety and defensiveness, influence mammography use, we conducted a survey mailed in 1988 to women medical school employees ages 35–65 (N = 719). Results: Overall, 66% of women reported having had a previous mammogram. A health care provider's request to have mammography was the most important determinant of use (relative risk [RR] = 6.3; 95% confidence interval [CI], 4.1 to 9.8; p <.001). Controlling for age-related differences in measures of anxiety and defensiveness, no effect of these traits on mammography use was found. Among the other features assessed, only increasing age was independently associated with use (RR = 1.2; 95% CI, 1.0 to 1.3). A perception that mammography is inconvenient was a potential barrier to mammography (RR = 0.8; 95% CI, 0.6 to 1.0; p =.06). Although an unexpectedly high proportion of women ages 35–40 had mammography (41%), of those who had been told to have a mammogram, 27% did not comply with recommendations compared with only 4% of women ages 50–65, p <.001. Conclusion: These findings emphasize the importance of the patient-provider interaction in influencing the use of mammography, especially in older women. The independent behavior of younger women regarding mammography decisions may reflect the controversy surrounding screening guidelines in women under 50 and has important implications for developing strategies to establish the appropriate use of mammography in younger women.