Attitudes Towards Mammography Among Rural-Residing Women Veterans Overdue for Breast Cancer Screening

Breast cancer screening enables the use of earlier treatment options and contributes to decreased mortality, however, there are urban-rural screening differences that impact the survival of rural women. Within the Department of Veterans Affairs (VA), rural-residing women veterans are 1 of the fastest growing groups to enroll in health care, but little is known about their access factors specific to screening mammography. The objective of this study was to examine mammography access factors among VA-enrolled rural women veterans overdue for breast cancer screening.

We conducted semi-structured interviews (n = 16) with rural-residing women veterans who were overdue for breast cancer screening for at least 12 months and received primary care services at a central Oregon VA community-based outpatient clinic. Interviews were audio-recorded, transcribed, and coded using a hybrid inductive-deductive approach to thematic analysis. Deductive coding was used to identify mammography access barriers and inductive coding was used to explore related aspects of veterans' clinical care experiences surrounding breast cancer screening.

Three themes were identified: (1) other health concerns interfere with screening; (2) screening avoidance because of a lack of geographically available gender-sensitive care tailored to women veterans; and (3) missed screening opportunities from gaps in communication and coordination processes.

Results illustrated mammography access barriers experienced by rural women veterans and underscored the importance of ensuring veterans' access to gender-sensitive and trauma-informed breast cancer screening.