Breast Cancer Research and Treatment

, Volume 164, Issue 3, pp 719–725 | Cite as

Nationwide cross-sectional adherence to mammography screening guidelines: national behavioral risk factor surveillance system survey results

  • Anand Narayan
  • Alexander Fischer
  • Zihe Zhang
  • Ryan Woods
  • Elizabeth Morris
  • Susan Harvey



Varying recommendations about breast cancer screening have generated much confusion about when and how often to undergo mammography screening, yet there is limited population-based data about the extent to which patients adhere to various mammographic screening guidelines in practice. Our purpose was to evaluate population-based adherence to mammographic screening using criteria from major guideline-producing organizations.


Women aged 40–74 in the 2014 Behavioral Risk Factor Surveillance System survey were included. Self-reported mammographic screening within 1 or 2 years, according to major guideline-producing organizations (American Cancer Society [ACS], US Preventative Services Task Force [USPSTF], American College of Radiology [ACR], American College of Obstetricians and Gynecologists [ACOG]) was calculated with logistic regression, adjusting for demographics and indices of access to health care.


159,123 women were included. By age category, cross-sectional adherence to USPSTF guidelines ranged from 76 to 81%, ACS (55–81%) and ACR/ACOG (45–64%) with increasing age being associated improved adherence. The highest proportions of women undergoing mammographic screening were seen in women ages 65–69 (66% within last year, 81% within last 2 years). Statistically significant predictors of adherence to mammography screening included increased income category (OR 1.08, 1.07–1.09), higher education category (OR 1.13, 1.11–1.16), and increased access to health care (OR 2.25, 1.94–2.60), adjusted for age categories.


Adherence to mammography screening was closest to USPSTF guidelines with 76–81% cross-sectional adherence. Frequency of screening increases with age with highest screening proportions in women ages 65–69 (66% within last year, 81% within last 2 years). For all screening guidelines, adherence to mammography screening remains poor in women with limited access to health insurance with less than half of women obtaining recommended screening.


Breast cancer Screening Guidelines Mammography Adherence 


  1. 1.
    Allen SV, Solberg Nes L, Marnach ML et al (2012) Patient understanding of the revised USPSTF screening mammogram guidelines: need for development of patient decision aids. BMC Womens Health 10(12):36. doi:10.1186/1472-6874-12-36 CrossRefGoogle Scholar
  2. 2.
    White A, Thompson TD, White MC et al (2017) Cancer screening test use—United States, 2015. MMWR Morb Mortal Wkly Rep 66:201–206CrossRefPubMedGoogle Scholar
  3. 3.
    Centers for Disease Control and Prevention (CDC) (2014) Behavioral risk factor surveillance system survey data. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, AtlantaGoogle Scholar
  4. 4.
    Siu AL (2016) U.S. Preventive Services Task Force. Screening for breast cancer: U.S. preventive services task force recommendation statement. Ann Intern Med 164(4):279–296. doi:10.7326/M15-2886 CrossRefPubMedGoogle Scholar
  5. 5.
    Oeffinger KC, Fontham ET, Etzioni R et al (2015) American cancer society. Breast cancer screening for women at average risk: 2015 guideline update from the American Cancer Society. JAMA 314(15):1599–1614CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Lee CH, Dershaw DD, Kopans D, Evans P et al (2010) Breast cancer screening with imaging: recommendations from the Society of Breast Imaging and the ACR on the use of mammography, breast MRI, breast ultrasound, and other technologies for the detection of clinically occult breast cancer. J Am Coll Radiol 7(1):18–27CrossRefPubMedGoogle Scholar
  7. 7.
    Paley PJ (2001) Screening for the major malignancies affecting women: current guidelines. Am J Obstet Gynecol. 184(5):1021–1030CrossRefPubMedGoogle Scholar
  8. 8.
    Gimeno García AZ (2012) Factors influencing colorectal cancer screening participation. Gastroenterol Res Pract 2012:483417CrossRefPubMedGoogle Scholar
  9. 9.
    Sammon JD, Pucheril D, Diaz M et al (2014) Contemporary nationwide patterns of self-reported prostate-specific antigen screening. JAMA Intern Med 174(11):1839–1841CrossRefPubMedGoogle Scholar
  10. 10.
    Institute of Medicine (2011) Clinical practice guidelines we can trust. National Academies Press, Washington, DCGoogle Scholar
  11. 11.
    Miglioretti DL, Zhu W, Kerlikowske K, Sprague BL, Onega T, Buist DS, Henderson LM, Smith RA (2015) Breast cancer surveillance consortium. Breast tumor prognostic characteristics and biennial vs annual mammography, age, and menopausal status. JAMA Oncol 1(8):1069–1077CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Selvin E, Brett KM (2003) Breast and cervical cancer screening: sociodemographic predictors among White, Black, and Hispanic women. Am J Public Health 93(4):618–623CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Smith-Bindman R, Miglioretti DL, Lurie N, Abraham L, Barbash RB, Strzelczyk J, Dignan M, Barlow WE, Beasley CM, Kerlikowske K (2006) Does utilization of screening mammography explain racial and ethnic differences in breast cancer? Ann Intern Med 144(8):541–553CrossRefPubMedGoogle Scholar
  14. 14.
    Peek ME, Han JH (2004) Disparities in screening mammography. Current status, interventions and implications. J Gen Intern Med 19(2):184–194CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    McPhee SJ, Nguyen TT, Shema SJ et al (2002) Validation of recall of breast and cervical cancer screening by women in an ethnically diverse population. Prev Med. 35:463–473CrossRefPubMedGoogle Scholar
  16. 16.
    Mandelblatt JS, Schechter CB, Yabroff KR, Lawrence W, Dignam J, Muennig P, Chavez Y, Cullen J, Fahs M (2004) Benefits and costs of interventions to improve breast cancer outcomes in African American women. J Clin Oncol 22(13):2554–2566CrossRefPubMedGoogle Scholar
  17. 17.
    Hubbard RA, O’Meara ES, Henderson LM, Hill D, Braithwaite D, Haas JS, Lee CI, Sprague BL, Alford-Teaster J, Tosteson AN, Wernli KJ, Onega T (2016) Multilevel factors associated with long-term adherence to screening mammography in older women in the U.S. Prev Med 89:169–177CrossRefPubMedGoogle Scholar
  18. 18.
    Davis WW, Parsons VL, Xie D, Schenker N, Town M, Raghunathan TE, Feuer EJ (2010) State-based estimates of mammography screening rates based on information from two health surveys. Public Health Rep 125(4):567–578PubMedPubMedCentralGoogle Scholar
  19. 19.
    Scheel JR, Hippe DS, Chen LE, Lam DL, Lee JM, Elmore JG, Rahbar H, Partridge SC, Lee CI (2016) Are physicians influenced by their own specialty society’s guidelines regarding mammography screening? An analysis of nationally representative data. AJR Am J Roentgenol 207:1–6CrossRefGoogle Scholar
  20. 20.
    O’Keefe EB, Meltzer JP, Bethea TN (2015) Health disparities and cancer: racial disparities in cancer mortality in the United States, 2000–2010. Front Public Health 15(3):51Google Scholar
  21. 21.
    Levano W, Miller JW, Leonard B et al (2014) Public education and targeted outreach to underserved women through the National Breast and Cervical Cancer Early Detection Program. Cancer 15(120 Suppl 16):2591–2596CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  1. 1.Memorial Sloan Kettering Cancer CenterNew YorkUSA
  2. 2.Johns Hopkins School of MedicineBaltimoreUSA
  3. 3.Johns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  4. 4.Johns Hopkins Department of RadiologyBaltimoreUSA

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