Mammography, clinical breast exam, and pap testing: correlates of combined screening

This study examines the correlates of screening for both breast and cervical cancer combined in a single indicator. Data used were from the 1990 National Health Interview Survey of Health Promotion and Disease Prevention. We used two indices to characterize the receipt of breast and cervical cancer screening among women 50-75 years of age. The first measure compared women who had three screening exams--clinical breast examination (CBE), mammography, and Pap test--in the past two years with those who had not received all three exams. The second measure compared women who had a Pap test and at least one breast screening exam (i.e., mammogram or CBE) in the previous two years with women who were underscreened. Age, level of education, smoking status, and access to health care were associated with both outcome measures. Black women were more likely to use screening services in the office setting (i.e., CBE and Pap), without a corresponding use of mammography. Nevertheless, more black than white women received a routine Pap test in combination with a CBE, a very positive trend with respect to the successful diffusion of at least two screening procedures among older black women. The data suggest that barriers to mammography screening remain even among women who are screened by CBE and Pap. Perhaps the biggest challenge is to educate primary care physicians and their patients to view different components of preventive health--CBE, Pap smear testing, breast self-examination, and mammographic screening--as equally necessary and interrelated. Medical Subject Headings (MeSH): screening, mammography, cervical cancer, Pap, breast exam.