The role of past mammography and future intentions in screening mammography usage

Screening mammography is effective in the early detection of breast cancer among women aged 50 through 69, but under utilization by the target age group is common. The present study determined how past mammography behavior and intentions to have a mammogram were related to screening behaviors, attitudes, and beliefs. Participants were 1211 Alberta women aged 40 through 75 without breast cancer who were surveyed in a population-based random digit dial telephone interview. The response rate was 78%. Based on the stages of change and adoption models, women were grouped as Screeners (N = 363, 30%), who had had a "checkup" mammogram in the past 24 months and intended to have another in the next 24 months; Intenders (N = 355, 28%), who had not had a mammogram in the past 24 months but intended to have one in the next 24 months; and Nonparticipants (N = 513, 42%), who neither had had a mammogram in the past 24 months nor intended to have one in the next 24 months. Compared with Screeners, both Intenders and Nonparticipants were more likely to live in the rural areas and to have lower educational levels. Nonparticipants were also older, less likely to be married, of lower income, and less likely to be employed outside of the home. Separate logistic regression analyses showed that both Intenders and Nonparticipants were significantly less able to encourage a friend to have a mammogram (OR = 2.7 and 4.4, respectively), more likely to believe that most women were not getting screening mammograms (OR = 1.7 and 2.9, respectively), and less likely to believe symptoms were not needed for mammograms (OR = 0.3 and 0.1, respectively). In addition, Nonparticipants were also significantly more likely to believe that getting a mammogram would not reassure others (OR = 4.0) and less able to talk to a doctor about getting a mammogram (OR = 5.2). Adoption of screening can be seen as a continuum in which Screeners had the most positive and Nonparticipants the most negative breast cancer screening attitudes, beliefs, and early detection behaviors. The importance of physician referral and utilization of other information dissemination channels was highlighted.