Access and barriers to mammography in New England community health centers

Historically, screening measures for poor patients have been underemployed. As a result, diagnosis of breast cancer is more likely made at later stages in underserved and minority populations. Regular care in community health centers (CHCs) can mitigate this screening inequity. The purpose of this study was to determine the barriers to and frequency of breast cancer screening in New England CHC women, and to compare our findings with the Healthy People 2000 goal of screening 60% of women aged 50 years and older with mammography every 2 years.

A consecutive series survey of 3176 women aged 40 years and older was performed between April 1 and August 31, 1995, at 32 CHCs in six states.

Completed questionnaires were returned on 2943 patients, including 200 African-American, 2222 white, 370 Hispanic, and 56 Asian women; 932 (32%) were aged 40 to 49 years, and 2011 (68%) were aged 50 and older. Within the preceding 2 years, 2072 (70%) had had a breast examination by a provider. Eighty-seven percent reported that mammography was recommended. More women aged 50 years and older (55%) had had mammography during the last 2 years than women in the 40- to 49-year-old group (45%) (P < .004). The most common reason for not having a mammogram was that the patient thought "the test was not important"; expense and lack of insurance was second. Hispanics had the lowest rates of mammography.

Progress is being made toward Healthy People 2000 goals in New England CHC women. Despite low income status, 55% of women aged > or = 50 years had had mammograms within the past 2 years. Once cost is removed as the greatest barrier, improving patient acceptance promises the largest increase in the use of mammography screening.