Marketing Mammograms to the Masses
A recent study published in the Archives of Internal Medicine found widespread confusion among women regarding the debate over when regular mammography screening should begin.
The controversy centers on when women who are not at an increased risk for breast cancer should begin having regular screening mammograms. Certain federal guidelines call for regular mammography screening to begin at age 50. However, the Susan G. Komen Breast Cancer Foundation and other breast cancer organizations strongly recommend that breast cancer screening begin at age 40.
Dr. Steven Woloshin of the Department of Veterans Affairs in White River Junction, Vermont and colleagues conducted a survey of 503 women to see how well they understood this highly contentious national debate.
About 95 percent of the women surveyed were generally aware of some type of controversy about mammograms; in fact more than 42 percent said they "paid a lot of attention" to its media coverage. However, while most may have been aware of the debate, their understanding of its actual message was apparently less clear.
Just under half (49 percent) of the women surveyed thought that the debate was about money-whether the cost of mammograms was reasonable. Possibly because they were unaware of the real controversy surrounding age and initial screening, more than 90 percent of the women believed that mammography should ideally begin at or before age 40.
In spite of such confusion, more women than ever are having mammograms-especially women over age 50. According to a report just released by the Centers for Disease Control and Prevention's National Center for Health Statistics, nearly 70 percent of women aged 50 and older reported having had a mammogram in the past two years. This is up from 61 percent in 1994-and 27 percent in 1987.
As predicted, income played a significant role in the rate of mammography screening. Seventy-two percent of women age 50 and older who were at or above the federal poverty level reported having a mammogram within the past two years, compared with only 53 percent of women below the federal poverty level. However, women at all income levels showed increases in mammography screening rates.
Research has shown that rural residents are screened for cancer less frequently than urban residents, often due a shortage of available health care professionals. One way that has been suggested to overcome this obstacle, especially in terms of breast cancer screening, is through the use of volunteers to encourage women to get mammograms.
However, in a large study involving 40 rural communities in the state of Washington, Robyn Andersen, Ph.D., and colleagues at the Fred Hutchinson Cancer Research Center in Seattle found that volunteers who provided breast cancer screening information and support had a disappointingly small impact on screening levels.
Writing in the American Journal of Preventive Medicine, Andersen reported on three approaches used to improve mammography screening rates through volunteer efforts: telephone reminders; educational efforts at community gathering places (bingo halls, beauty parlors, neighborhood picnics); and the distribution of mammography literature at local clubs, stores, libraries, etc.
After a follow-up period of three years, the researchers found that each kind of volunteer effort had achieved positive, but very modest, improvements in mammography use among the 6,592 women in the study. The results, they said, were consistent with other large community trials that employed similar techniques.
While the three approaches achieved similar results, the second approach, which emphasized outreach during community activities, was found to be the most effective. In fact, it was the only approach that resulted in a statistically significant improvement in mammography usage (2.9 percent).
In contrast, another Washington-based study by Dr. Stephen Taplin from Group Health Cooperative of Puget Sound in Seattle and colleagues concluded that a telephone reminder nearly doubled the likelihood that a woman would eventually get a mammogram. Interestingly, the researchers found that a short reminder call was just as effective as a longer call that delved into a woman's concerns about mammography.
Taplin's team studied 1,765 women who had not scheduled a mammogram within two months of receiving a mailed recommendation that they do so. The women were randomly assigned to receive either a follow-up postcard, a reminder telephone call, or a longer motivational call that addressed possible cultural- or income-related barriers.
Of the women who received a postcard reminder, slightly more than a third (35.4 percent) scheduled a mammogram within a year. More than half (51.8 percent) of the women who received a brief phone call, and just under half (49.8 percent) of the women who received a longer "motivational" call, eventually scheduled a mammogram.
Writing in the Journal of the National Cancer Institute, the researchers concluded that women who received either type of phone call were 1.9 times as likely to then schedule a mammogram as those who only received the postcard reminder. Furthermore, women who had a mammogram in the past were three times more likely to get a mammogram than women who had never been screened. Also, women with higher incomes were more likely to get a mammogram than those at lower income levels.
In 1992, Congress enacted the Mammography Quality Standards Act (MQSA) to ensure that all women have access to quality mammography for the detection of breast cancer in its earliest, most treatable stages. In the fall of 1998, Congress reauthorized the MQSA, extending the program to 2002.
Congress charged the Food and Drug Administration with developing and implementing regulations to help ensure that mammography is safe and reliable and that consumers receive uniformly high-quality services from facilities throughout the United States.
To find an FDA-certified mammography facility in your area, or to see if the facility you currently use is authorized, you can call the FDA's MQSA hotline at 1-800-4-CANCER or visit the FDA website at http://www.fda.gov/cdrh/mammography/consumers.
SOURCES:
Archives of Internal Medicine, May 22, 2000; 160: 1434-1440
"Health, United States: 2000," National Center for Health Statistics, U.S. Centers for Disease Control and Prevention
American Journal of Preventive Medicine, April 1, 2000; 18: 199-207
Journal of the National Cancer Institute, February 2, 2000; 92: 233-242
Archives of Internal Medicine, May 2, 2000; 132: 697-704, 732-734
U.S. Food and Drug Administration
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