Breast Cancer Research and Treatment

, Volume 101, Issue 3, pp 317–324 | Cite as

Factors associated with the incompliance with mammogram screening among individuals with a family history of breast cancer or ovarian cancer

  • Hongyu Wu
  • Kangmin Zhu
  • Ismail Jatoi
  • Mona Shah
  • Craig D. Shriver
  • John Potter



The national guidelines recommend more intensive screening for breast cancer for women with a family history of breast or ovarian cancer. Using the data from the 2000 National Health Interview Survey (NHIS), we examined factors related to the underuse of mammogram in this population.


The study subjects were 1,215 women aged 30–79 who had a family history of breast or ovarian cancer in their first-degree relatives. According to the American Cancer Society’s guidelines for breast cancer screening, having no mammogram in last year was used as an outcome for this study. Socio-demographic characteristics, health-related conditions, lifestyle factors, health behaviors, menstrual/reproductive information and health care access and utilization were analyzed to assess their relations to mammogram underuse using unconditional logistic regression method.


The results showed that younger age, having no place to go when sick (OR = 2.2, 95% CI, 1.2–4.0), having no visits to a general doctor (OR = 1.7, 95% CI, 1.2–2.4) or medical specialist (OR = 2.2, 95% CI, 1.6–3.1) and having no influenza shot in last year (OR = 1.7, 95% CI, 1.2–2.3) increased the risk of underusing mammography screening among women who had a family history of breast or ovarian cancer. Women who had no home care from health professionals in the last year were less likely to underuse mammogram with an OR of 0.3 (95% CI, 0.1–0.6), compared with women who had.


Medical care-related factors may affect the use of mammography screening in women with a family history of breast or ovarian cancer.


Factors Family history of breast cancer Mammogram National survey Cancer screening 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Jemal A, Murray T, Ward E, Samuels A, Tiwari R, Ghafoor A, Feuer E, Thun M (2005) Cancer statistics, 2005. CA Cancer J Clin 55(1):10–30PubMedGoogle Scholar
  2. 2.
    Barton M (2005) Breast cancer screening. Benefits, risks, and␣current controversies. Postgrad Med 118(2):27–28, 33–26, 46Google Scholar
  3. 3.
    Peto R, Bireham H, Clarke M, Davies C, Beral V (2000) UK and USA breast cancer deaths down 25% in year 2000 at ages 20–69 years. Lancet 355(9217):1822PubMedCrossRefGoogle Scholar
  4. 4.
    Kerlikowske K, Grady D, Rubin S, Sandrock C, Ernster V (1995) Efficacy of screening mammography. A meta-analysis. JAMA 273(2):149–154PubMedCrossRefGoogle Scholar
  5. 5.
    Humphrey L, Helfand M, Chan B, Woolf S (2002) Breast cancer screening: a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 137(5 Part 1):347–360PubMedGoogle Scholar
  6. 6.
    Dumitrescu R, Cotarla I (2005) Understanding breast cancer risk – where do we stand in 2005? J Cell Mol Med 9(1):208–221PubMedCrossRefGoogle Scholar
  7. 7.
    Petrakis N, Ernster V, King M-C: Breast. In: Schottenfeld D, Fraumeni JF (eds) Cancer epidemiology, prevention 1982:855–870Google Scholar
  8. 8.
    Magnusson C, Colditz G, Rosner B, Bergstrom R, Persson I (1998) Association of family history and other risk factors with breast cancer risk (Sweden). Cancer Causes Control 9(3):259–267PubMedCrossRefGoogle Scholar
  9. 9.
    Familial breast cancer (2001) collaborative reanalysis of individual data from 52 epidemiological studies including 58,209 women with breast cancer and 101,986 women without the disease. Lancet 358:1389–1399CrossRefGoogle Scholar
  10. 10.
    National Institutes of Health Consensus Development Conference Statement: Breast Cancer Screening for Women Ages 40–49, January 21–23, 1997. National Institutes of Health Consensus Development Panel. J Natl Cancer Inst 1997 Jul 16, 89(14):1015–1026Google Scholar
  11. 11.
    Spyckerelle Y, Kuntz C, Giordanella J, Ancelle-Park R (2002) Mammography use among women aged 35 to 75 years. Bull Cancer 89(11):957–962PubMedGoogle Scholar
  12. 12.
    Andersen M, Smith R, Meischke H, Bowen D, Urban N (2003) Breast cancer worry and mammography use by women with and without a family history in a population-based sample. Cancer Epidemiol Biomarkers Prev 12(4):314–320PubMedGoogle Scholar
  13. 13.
    Rahman S, Dignan M, Shelton B (2003) Factors influencing adherence to guidelines for screening mammography among women aged 40 years and older. Ethn Dis 13(4):477–484PubMedGoogle Scholar
  14. 14.
    Hailey B, Carter C, Burnett D (2000) Breast cancer attitudes, knowledge, and screening behavior in women with and without a family history of breast cancer. Health Care Women Int 21(8):701–715PubMedCrossRefGoogle Scholar
  15. 15.
    Isaacs C, Peshkin B, Schwartz M, Demarco T, Main D, Lerman C (2002) Breast and ovarian cancer screening practices in healthy women with a strong family history of breast or ovarian cancer. Breast Cancer Res Treat 71(2):103–112PubMedCrossRefGoogle Scholar
  16. 16.
    Husaini B, Sherkat D, Bragg R, Levine R, Emerson J, Mentes C, Cain V (2001) Predictors of breast cancer screening in a panel study of African American women. Women Health 34(3):35–51PubMedCrossRefGoogle Scholar
  17. 17.
    The National Cancer Institute Breast Cancer Screening Consortium (1990) Screening mammography: a missed clinical opportunity? JAMA 264(1):54–58Google Scholar
  18. 18.
    O’Connor A, Perrault D (1995) Importance of physician’s role highlighted in survey of women’s breast screening practices. Canadian Journal of Public Health 86(1):42–45Google Scholar
  19. 19.
    Mastroberti M, Stein J (1996) Barriers to timely mammography. HMO Practice 10(3):104–107PubMedGoogle Scholar
  20. 20.
    Munn E (1993) Nonparticipation in mammography screening: apathy, anxiety or cost? N Z Med J 106(959):284–286PubMedGoogle Scholar
  21. 21.
    Swan J, Breen N, Coates R, Rimer B, Lee N (2003) Progress in cancer screening practices in the United States: results from the 2000 National Health Interview Survey. Cancer Causes Control 97(6):1528–1540Google Scholar
  22. 22.
    Ho V, Yamal J, Atkinson E, Basen-Engquist K, Tortolero-Luna G, Follen M (2005) Predictors of breast and cervical screening in Vietnamese women in Harris County, Houston, Texas. Cancer Nurs 28(2):119–129PubMedCrossRefGoogle Scholar
  23. 23.
    Friedman L, Woodruff A, Lane M, Weinberg A, Cooper H, Webb J (1995) Breast cancer screening behaviors and intentions among asymptomatic women 50 years of age and older. Am J Prev Med 11(4):218–223PubMedGoogle Scholar
  24. 24.
    Breen N, Kessler L (1994) Changes in the use of screening mammography: evidence from the 1987 and 1990 national health interview surveys. Am J Public Health 84(1):62–67PubMedGoogle Scholar
  25. 25.
    Miller A, Champion V (1996) Mammography in older women: one-time and three-year adherence to guidelines. Nursing Research 45(4):239–245PubMedCrossRefGoogle Scholar
  26. 26.
    Vernon S, Vogel V, Halabi S, Jackson G, Lundy R, Peters G (1992) Breast cancer screening behaviors and attitudes in three racial/ethnic groups. Cancer 69(1):165–174PubMedCrossRefGoogle Scholar
  27. 27.
    Pearlman D, Rakowski W, Ehrich B, Clark M (1996) Breast cancer screening practices among African-American, Hispanic, and white women: reassessing differences. Am J Prev Med 12:327–337PubMedGoogle Scholar
  28. 28.
    Cummings D, Whetstone L, Shende A, Weismiller D (2000) Predictors of screening mammography: implications for office practice. Arch Fam Med 9(9):870–875PubMedCrossRefGoogle Scholar
  29. 29.
    Smith R, Saslow D, Sawyer K, Burke W, Costanza M, Evans Wr, Foster RJ, Hendrick E, Eyre H, Sener S (2003) American Cancer Society High-Risk Work Group; American Cancer Society Screening Older Women Work Group; American Cancer Society Mammography Work Group; American Cancer Society Physical Examination Work Group; American Cancer Society New Technologies Work Group; American Cancer Society Breast Cancer Advisory Group. American Cancer Society guidelines for breast cancer screening: update 2003. CA Cancer J Clin 53(3):141–169PubMedGoogle Scholar
  30. 30.
    Hanlon J, Fillenbaum G, Kuchibhatla M, Artz M, Boult C, Gross C (2002) Impact of inappropriate drug use on mortality and functional status in representative community dwelling elders. Med Care 40(2):166–176PubMedCrossRefGoogle Scholar
  31. 31.
    Wright D (2002) State Estimates of Substance Use from the 2000 National Household Survey on Drug Abuse: Volume II. Supplementary Technical Appendices (DHHS Publication No. SMA 02–3732, NHSDA Series H-16). Rockville, MD: Substance Abuse and Mental Health Services Administration, Office of Applied StudiesGoogle Scholar
  32. 32.
    Cheung A, Chaudhry R, Kapral M, Jackevicius C, Robinson G (2004) Perimenopausal and postmenopausal health. BMC Women Health Suppl 1:s23CrossRefGoogle Scholar
  33. 33.
    Martin L, Calle E, Wingo P, Heath CJ (1996) Comparison of mammography and Pap test use from the 1987 and 1992 National Health Interview Surveys: are we closing the gaps? Am J Prev Med 12:82–90PubMedGoogle Scholar
  34. 34.
    Calle E, Flanders W, Thun M, Martin L (1993) Demographic predictors of mammography and Pap smear screening in U.S. women. Am J Public Health 83:53–60PubMedGoogle Scholar
  35. 35.
    Phillips K, Kerlikowske K, Baker L, Chang S, Brown M (1998) Factors associated with women?s adherence to mammography screening guidelines. Health Serv Res 33:29–53PubMedGoogle Scholar
  36. 36.
    Coughlin S, Thompson T, Hall H, Logan P, Uhler R (2002) Breast and cervical carcinoma screening practices among women in rural and nonrural areas of the United States, 1998–1999. Cancer 94(11):2801–2812PubMedCrossRefGoogle Scholar
  37. 37.
    Breen N, Wagener D, Brown M, Davis W, Ballard-Barbash R (2001) Progress in cancer screening over a decade: results of cancer screening from the 1987, 1992 and 1998 National Health Interview Surveys. J Natl Cancer Inst 93:1704–1713PubMedCrossRefGoogle Scholar
  38. 38.
    Selvin E, Brett K (2003) Breast and cervical cancer screening: sociodemographic predictors among White, Black, and Hispanic women. Am J Public Health 93(4):618–623PubMedGoogle Scholar
  39. 39.
    Damewood M (1997) Hormonal strategies of the menopause. Md Med J 46(8):415–418PubMedGoogle Scholar
  40. 40.
    Burack R, Liang J (1989) The acceptance and completion of mammography by older black women. Am J Public Health 79(6):721–726PubMedCrossRefGoogle Scholar
  41. 41.
    Shoen R, Marcus M, Braham R (1994) Factors associated with the use of screening mammography in a primary care setting. J Community Health 19(4):239–252CrossRefGoogle Scholar
  42. 42.
    Kiefe C, Funkhouser E, Fouad M, May D (1998) Chronic disease as a barrier to breast and cervical cancer screening. J Gen Intern Med 13(6):357–365PubMedCrossRefGoogle Scholar
  43. 43.
    Bostick R, Sprafka J, Virnig B, Potter J (1994) Predictors of cancer prevention attitudes and participation in cancer screening examinations. Prev Med 23:816–826PubMedCrossRefGoogle Scholar
  44. 44.
    Chao A, Paganini-Hill A, Ross R, Henderson B (1987) Use of preventive care by the elderly. Prev Med 16:710–722PubMedCrossRefGoogle Scholar
  45. 45.
    Crawford J, Cohen H (1985) Aging and neoplasia. Ann Rev Gerontol Geriatr 4:3–32Google Scholar
  46. 46.
    Caplan L, McQueen D, Qualters J, Leff M, Garrett C, Calonge N (2003) Validity of women’s self-reports of cancer screening test utilization in a managed care population. Cancer Epidemiol Biomarkers Prev 12(11 Pt 1):1182–1187PubMedGoogle Scholar
  47. 47.
    Paskett E, Tatum C, Mack D, Hoen H, Case L, Velez R (1996) Validation of self-reported breast and cervical cancer screening tests among low-income minority women. Cancer Epidemiol Biomarkers Prev 5(9):721–726PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2006

Authors and Affiliations

  • Hongyu Wu
    • 1
  • Kangmin Zhu
    • 1
  • Ismail Jatoi
    • 2
  • Mona Shah
    • 1
  • Craig D. Shriver
    • 3
  • John Potter
    • 1
  1. 1.United States Military Cancer Institute, Walter Reed Army Medical CenterWashingtonUSA
  2. 2.Department of SurgeryUniformed Services University of the Health SciencesBethesdaUSA
  3. 3.Comprehensive Breast CenterWalter Reed Army Medical CenterWashingtonUSA

Personalised recommendations