Oncology/endocrine
Trends in Mammography and Clinical Breast Examination: A Population-Based Study

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Background

There are well-accepted clinical guidelines for early detection of breast cancer through mammography and clinical breast examination. The purpose of this study was to determine trends in the utilization of these techniques over the past 5 years.

Methods

The National Health Interview Survey is a population-based computer survey of noninstitutionalized civilian Americans conducted annually by the National Center for Health Statistics, Centers for Disease Control and Prevention. We evaluated the reported use of mammography and clinical breast examination in women 40 years of age and older between 2000 and 2005. Data were evaluated using SAS and SAS-callable SUDAAN software.

Results

Surveyed were 10,994 and 11,128 women over age 40 in 2000 and 2005, respectively. Between these years, there was a decline in women ≥40 years old who reported ever having a mammogram (80.79% versus 79.52%, P < 0.0001) and in those who had a mammogram within the preceding 2 years (87.98% versus 86.30%, P = 0.0040). In addition, there was a drop in women reporting ever having a clinical breast exam (82.12% versus 75.91%, P < 0.0001) and in those reporting having had a clinical breast exam in the 2 years prior to the survey (89.24% versus 87.63%, P = 0.0012). Similar results were found in the population aged 50–69.

Conclusions

Despite well-established clinical guidelines for early detection of breast cancer, there has been a decline in the rates of annual mammography and clinical breast exam in women over the age of 40 over the past 5 years.

Introduction

Breast cancer is the leading malignancy affecting women in the United States, and the second leading cause of cancer-related deaths [1]. It has been well-established that breast cancers detected on screening mammography tend to be smaller, less likely to spread to lymph nodes, and more apt to be treated with breast-conserving surgery and without toxic chemotherapy than those detected by clinical examination alone [2]. As a result of general agreement regarding the effectiveness of mammography in reducing breast cancer-related mortality, a number of clinical practice guidelines have been established promoting widespread screening mammography [3]. While these guidelines vary in terms of the appropriate age at which to begin screening and the frequency of mammography, there is a general consensus that mammography is effective in reducing breast cancer-related deaths [3].

Despite guidelines recommending mammography and the preponderance of clinical trial data suggesting an improvement in survival associated with it, previous studies have found that only 70% of American women over the age of 40 comply with these guidelines [4]. The purpose of this study was to analyze, in a population-based fashion, whether the use of mammography and clinical breast examination have improved over the past 5 years.

Section snippets

Methods

The National Health Interview Survey (NHIS) is a face-to-face nationally representative population-based health survey conducted annually by the National Center for Health Statistics, Centers for Disease Control and Prevention. The NHIS consists of two main components: the “Basic Module,” containing basic health and demographic information, and “Supplements,” which relate to specific areas of interest. A cancer supplement was fielded in both 2000 and 2005. These datasets include information

Results

In 2000, a total of 10,994 women 40 years of age or older representing 61,249,236 women in the noninstitutionalized civilian US population were surveyed. In 2005, a total of 11,128 women 40 years of age or older representing 68,891,543 women in the population were surveyed. Comparative sociodemographic and breast cancer risk factors between these two populations are shown in Table 2.

There was a decline in the number of women 40 years of age or older who reported ever having had a mammogram

Discussion

While there has been a decrease in the incidence of breast cancer over the past several years, this disease continues to be a significant source of morbidity and mortality among America women, claiming more than 40,000 lives in 2005 alone [7]. Yet, it is also one of the most treatable malignancies when detected at an early stage. To date, there have been eight randomized controlled trials evaluating the effectiveness of screening mammography [8, 9, 10, 11, 12, 13, 14, 15, 16]. While each of

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