Initial and repeat mammography screening: different behaviors/different predictors

Despite evidence of the efficacy of mammography in early detection of breast cancer, many women choose not to have a mammogram. Some women who have an initial mammogram do not return for a second one. Many others, especially minority women, and those who live in rural areas or in a low socioeconomic class, are not being screened according to recommended guidelines. The full benefits of early detection are available only if women receive regular screening. This study of 830 randomly selected women over age 50 from rural, eastern North Carolina included women who had never had a mammogram (213), women who had had a mammogram but not in the prior 2 years (89), and women who reported having had a mammogram in the previous 2 years (528). Logistic regression was used to identify significant mammography predictor variables. The results support the robust role that provider recommendation plays in encouraging mammography behavior; they also demonstrate that past behavior is also a strong predictor of future screening participation. Only 13% of the women who had never had a mammogram reported obtaining a referral from their provider compared with 79% of the women who had a mammogram in the previous 2 years. Likewise, 75% of the women who had engaged in mammography behavior in the prior 2 years expressed a positive intention to be screened in the next year compared with only 14% of those women who had never had a mammogram. Initial and repeat mammography screenings are different behaviors and are influenced by different factors. For provider counseling to be effective, the strategies employed need to consider past behavior as well as current recommendations, and they must incorporate a discussion of beliefs as well as reinforcement of regular screening behavior.