Which women aren’t getting mammograms and why? (United States)



This study investigates why women who reported no recent mammogram did not get the test.


Using data from the 2000 National Health Interview Survey (NHIS), we examine correlates of mammography use among women 40 years and older (n = 10,212), with particular focus on the 30% (n = 3,188) who reported no recent mammogram. Non-screening is examined in the context of two important correlates of mammography use—access to health care and a physician’s recommendation to get a mammogram.


In total, 80% of non-screeners who reported having access to healthcare did not receive a recommendation for a mammogram. Women age 65 years and older were more likely than younger women to report not receiving a recommendation (OR 1.77, 95% CI 1.25–2.50). For women who reported having access, non-screening was significantly more likely among younger women (40–49), those with less education, incomes less than $20,000, residence outside Metropolitan Statistical Areas (MSAs) and no family history of breast cancer. Among women with access problems, those who had not visited a primary care provider in the past year were much more likely to be non-screeners (80%) compared with those who had seen a provider (46%). Among women with access, those who reported put it off as the main reason for non-screening were significantly more likely to be younger and to be born in the U.S. than women who said that they didn’t know they needed a mammogram.


Most non-screeners report not receiving a physician recommendation for mammography. Although a minority reported access problems, the effect of lacking access on utilization was strong and is accentuated when women without access do not see a doctor. These findings confirm the importance of a mammography recommendation and raise questions concerning whether this information is being conveyed by physicians or heard by patients.

This is a preview of subscription content, access via your institution.

Fig. 1


  1. 1.

    U.S. Preventive Services Task Force (2002) Screening for breast cancer: recommendations and rationale. Ann Intern Med 137:344–346

    Google Scholar 

  2. 2.

    Swan J, Breen N, Coates RJ, Rimer BK, Lee NC (2003) Progress in cancer screening practices in the United States: results from the 2000 National Health Interview Survey. Cancer 97:1528–1540

    PubMed  Article  Google Scholar 

  3. 3.

    Legler J, Meissner HI, Coyne C, Breen N, Chollette V, Rimer BK (2002) The effectiveness of interventions to promote mammography among women with historically lower rates of screening. Cancer Epidemiol Biomarkers Prev 11:59–71

    PubMed  Google Scholar 

  4. 4.

    Rimer B, Meissner HI, Breen N, Legler J, Coyne C (2001) Social and behavioral interventions to increase breast cancer screening. In: Schneiderman N, Speers MA, Silva JM, Tomes H, Gentry JH, (eds). Integrating behavioral and social sciences with public health. Washington, D.C., American Psychological Association, pp 177–201

    Chapter  Google Scholar 

  5. 5.

    Vernon SW, Laville EA, Jackson GL (1990) Participation in breast screening programs: a review. Soc Sci Med 30:1107–1118

    PubMed  Article  CAS  Google Scholar 

  6. 6.

    Mandelblatt JS, Gold K, O’Malley AS, et al (1999) Breast and cervix cancer screening among multiethnic women: role of age, health, and source of care. Prev Med 28:418–425

    PubMed  Article  CAS  Google Scholar 

  7. 7.

    Hiatt RA, Pasick RJ (1996) Unsolved problems in early breast cancer detection: focus on the underserved. Breast Cancer Res Treat 40:37–51

    PubMed  Article  CAS  Google Scholar 

  8. 8.

    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 84:62–67

    PubMed  CAS  Google Scholar 

  9. 9.

    Hiatt RA, Klabunde C, Breen N, Swan J, Ballard-Barbash R (2002) Cancer screening practices from national health interview surveys: past, present, and future. J Natl Cancer Inst 94:1837–1846

    PubMed  Google Scholar 

  10. 10.

    Kiefe CI, McKay SV, Halevy A, Brody BA (1994) Is cost a barrier to screening mammography for low-income women receiving medicare benefits? A randomized trial. Arch Intern Med 154:1217–1224

    PubMed  Article  CAS  Google Scholar 

  11. 11.

    Breen N, Wagener DK, Brown ML, Davis WW, 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 93:1704–1713

    PubMed  Article  CAS  Google Scholar 

  12. 12.

    Hsia J, Kemper E, Kiefe C, et al (2000) The importance of health insurance as a determinant of cancer screening: evidence from the women’s health initiative. Prev Med 31:261–270

    PubMed  Article  CAS  Google Scholar 

  13. 13.

    Kirkman-Liff B, Kronenfeld JJ (1992) Access to cancer screening services for women. Am J Public Health 82:733–735

    PubMed  CAS  Article  Google Scholar 

  14. 14.

    Fox SA, Klos DS, Tsou CV (1988) Underuse of screening mammography by family physicians. Radiology 166:431–433

    PubMed  CAS  Google Scholar 

  15. 15.

    Fox SA, Murata PJ, Stein JA (1991) The impact of physician compliance on screening mammography for older women. Arch Intern Med 151:50–56

    PubMed  Article  CAS  Google Scholar 

  16. 16.

    NCI Breast Cancer Screening Consortium (1990) Screening mammography: a missed clinical opportunity? Results of the NCI breast cancer screening consortium and national health interview survey studies. J Am Med Assoc 264:54–58

    Google Scholar 

  17. 17.

    Vernon SW, Vogel VG, Halabi S, Jackson GL, Lundy RO, Peters GN (1992) Breast cancer screening behaviors and attitudes in three racial/ethnic groups. Cancer 69:165–174

    PubMed  Article  CAS  Google Scholar 

  18. 18.

    Fox SA, Stein JA (1991) The effect of physician–patient communication on mammography utilization by different ethnic groups. Med Care 29:1065–1082

    PubMed  Article  CAS  Google Scholar 

  19. 19.

    Roetzheim RG, Fox SA, Leake B (1995) Physician-reported determinants of screening mammography in older women: the impact of physician and practice characteristics. J Am Geriatr Soc 43:1398–1402

    PubMed  CAS  Google Scholar 

  20. 20.

    Humphrey LL, Helfand M, Chan BK, Woolf SH (2002) Breast cancer screening: a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 137:347–360

    PubMed  Google Scholar 

  21. 21.

    National Research Council (1992) Toward a national health care survey. A data system for 21st century. Washington, DC: National Academy Press,

    Google Scholar 

  22. 22.

    National Center for Health Statistics (2001) Data file documentation, National Health Interview Survey, 2000 [machine readable data file and documentation). Hyattsville: National Center for Health Statistics

    Google Scholar 

  23. 23.

    Botman SL, Moore TF, Moriarity CL, Parsons VL (2000) Design and estimation for the National Health Interview Survey, 1995–2004. Vital Health Statistics 2

  24. 24.

    Korn EL, Graubard BI (1999) Analysis of Health Surveys. New York: John Wiley and Sons

    Google Scholar 

  25. 25.

    SAS Institute Inc. (1999) SAS/STAT user’s guide, version 8. SAS Institute Inc

  26. 26.

    SUDAAN (2002) SUDAAN user’s manual, release 8.0.1. Research Triangle Institute

  27. 27.

    Zapka JG, Lemon SC (2004) Interventions for patients, providers and health care organizations. Cancer 101:1165–1187

    PubMed  Article  Google Scholar 

  28. 28.

    Wagner TH (1998) The effectiveness of mailed patient reminders on mammography screening: a meta-analysis. Am J Prev Med 14:64–70

    PubMed  Article  CAS  Google Scholar 

  29. 29.

    Snell JL, Buck EL (1996) Increasing cancer screening: a meta-analysis. Prev Med 25:702–707

    PubMed  Article  CAS  Google Scholar 

  30. 30.

    Cohen D, DiCicco-Bloom B, Ohman Strickland P, et al (2004) Opportunistic approaches for delivering preventive care in illness visits. Prev Med 38:565–573

    PubMed  Article  Google Scholar 

  31. 31.

    Walter LC, Lewis CL, Barton MB (2005) Screening for colorectal, breast, and cervical cancer in the elderly: a review of the evidence. Am J Med 118:1078–1086

    PubMed  Article  Google Scholar 

  32. 32.

    Sabatino SA, Burns RB, Davis RB, Phillips RS, Chen YH, McCarthy EP (2004) Breast carcinoma screening and risk perception among women at increased risk for breast carcinoma. Cancer 100:2338–2346

    PubMed  Article  Google Scholar 

Download references


The authors wish to thank Jon Kerner for his careful review and helpful suggestions for revision and Tim McNeel for expert programing.

Author information



Corresponding author

Correspondence to Helen I. Meissner.

Additional information

Funding: Dr. Vernon’s work was supported by a National Cancer Institute grant R01 CA76330 and R01CA97263

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Meissner, H.I., Breen, N., Taubman, M.L. et al. Which women aren’t getting mammograms and why? (United States). Cancer Causes Control 18, 61–70 (2007). https://doi.org/10.1007/s10552-006-0078-7

Download citation


  • Mammography
  • Communications barriers
  • Access to health care
  • Breast neoplasms