Breast Cancer Risk and Provider Recommendation for Mammography Among Recently Unscreened Women in the United States


  • The authors have no conflicts of interest to report.

  • Abstract presented at Regional Meeting of the Society of General Internal Medicine, Boston, MA March 5, 2004, the Annual Meeting of the Society of General Internal Medicine Chicago, IL May 13, 2004 and at the National Research Service Awards Conference, San Diego, CA, June 5, 2004.

Address correspondence and reprint requests to Dr. Sabatino: Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control, mailstop K-52, 4770 Buford Highway, Atlanta, GA 30341 (e-mail:


BACKGROUND AND OBJECTIVE: Many women with increased breast cancer risk have not been screened recently. Provider recommendation for mammography is an important reason many women undergo screening. We examined the association between breast cancer risk and reported provider recommendation for mammography in recently unscreened women.

DESIGN: Cross-sectional study using 2000 National Health Interview Survey.

PARTICIPANTS: In all, 1673 women ages 40 to 75 years without cancer who saw a health care provider in the prior year and had no mammogram within 2 years.

MEASUREMENTS AND ANALYSIS: We assessed breast cancer risk by Gail score and risk factors. We used multivariable logistic regression models in SUDAAN adjusted for age, race and illness burden, to examine the association between risk and reported recommendation for mammography within 1 year for all women and women ages 50 to 75 years.

RESULTS: Of 1673 recently unscreened women, 29% reported a recommendation. Twelve percent of women had increased Gail risk and of these recently unscreened, high-risk women, 25% reported a recommendation. After adjustment, high-risk women were not more likely to report a recommendation than average-risk women. Results were similar for women 50 to 75 years old. No individual breast cancer factors other than age were associated with reporting a recommendation.

CONCLUSIONS: Approximately 70% of recently unscreened women seen by a health care provider in the prior year reported no recommendation for mammography, regardless of breast cancer risk. This did not include women who received a recommendation and were screened. Increasing reported recommendation rates may represent an opportunity to increase screening participation among recently unscreened women, particularly for women with increased breast cancer risk.