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Mammography screening can reduce breast cancer mortality. However, most women are unaware that inconsequential disease can also be detected by screening, leading to overdiagnosis and overtreatment. We aimed to investigate whether including information about overdetection of breast cancer in a decision aid would help women aged around 50 years to make an informed choice about breast screening. We did a community-based, parallel-group, randomised controlled trial in New South Wales, Australia, using a random cohort of women aged 48–50 years. Recruitment to the study was done by telephone; women were eligible if they had not had mammography in the past 2 years and did not have a personal or strong family history of breast cancer. With a computer program, we randomly assigned 879 participants to either the intervention decision aid (comprising evidence-based explanatory and quantitative information on overdetection, breast cancer mortality reduction, and false positives) or a control decision aid (including information on breast cancer mortality reduction and false positives). Participants and interviewers were masked to group assignment. The primary outcome was informed choice (defined as adequate knowledge and consistency between attitudes and screening intentions), which we assessed by telephone interview about 3 weeks after random allocation. The primary outcome was analysed in all women who completed the relevant follow-up interview questions fully. This trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12613001035718. Between January, 2014, and July, 2014, 440 women were allocated to the intervention group and 439 were assigned to the control group. 21 women in the intervention group and 20 controls were lost to follow-up; a further ten women assigned to the intervention and 11 controls did not answer all questions on attitudes. Therefore, 409 women in the intervention group and 408 controls were analysed for the primary outcome. 99 (24%) of 409 women in the intervention group made an informed choice compared with 63 (15%) of 408 in the control group (difference 9%, 95% CI 3–14; p=0·0017). Compared with controls, more women in the intervention group met the threshold for adequate overall knowledge (122/419 [29%] vs 71/419 [17%]; difference 12%, 95% CI 6–18; p<0·0001), fewer women expressed positive attitudes towards screening (282/409 [69%] vs 340/408 [83%]; 14%, 9–20; p<0·0001), and fewer women intended to be screened (308/419 [74%] vs 363/419 [87%]; 13%, 8–19; p<0·0001). When conceptual knowledge alone was considered, 203 (50%) of 409 women in the intervention group made an informed choice compared with 79 (19%) of 408 in the control group (p<0·0001). Information on overdetection of breast cancer provided within a decision aid increased the number of women making an informed choice about breast screening. Becoming better informed might mean women are less likely to choose screening. Australian National Health and Medical Research Council.

In this article, the American Cancer Society provides an overview of female breast cancer statistics in the United States, including data on incidence, mortality, survival, and screening. Approximately 231,840 new cases of invasive breast cancer and 40,290 breast cancer deaths are expected to occur among US women in 2015. Breast cancer incidence rates increased among non-Hispanic black (black) and Asian/Pacific Islander women and were stable among non-Hispanic white (white), Hispanic, and American Indian/Alaska Native women from 2008 to 2012. Although white women have historically had higher incidence rates than black women, in 2012, the rates converged. Notably, during 2008 through 2012, incidence rates were significantly higher in black women compared with white women in 7 states, primarily located in the South. From 1989 to 2012, breast cancer death rates decreased by 36%, which translates to 249,000 breast cancer deaths averted in the United States over this period. This decrease in death rates was evident in all racial/ethnic groups except American Indians/Alaska Natives. However, the mortality disparity between black and white women nationwide has continued to widen; and, by 2012, death rates were 42% higher in black women than in white women. During 2003 through 2012, breast cancer death rates declined for white women in all 50 states; but, for black women, declines occurred in 27 of 30 states that had sufficient data to analyze trends. In 3 states (Mississippi, Oklahoma, and Wisconsin), breast cancer death rates in black women were stable during 2003 through 2012. Widening racial disparities in breast cancer mortality are likely to continue, at least in the short term, in view of the increasing trends in breast cancer incidence rates in black women.

Background: Medicare data may be a useful source for determining the utilization of mammography among elderly women, but the accuracy of these data has not been established. Objective: We determined whether Medicare physician billing claims are an accurate reflection of mammography utilization among women ages 65 and older and whether they can be used to assess the use of screening as compared with diagnostic mammography. Data Sources: Mammography use was assessed using Medicare billing claims and radiology reports from 2 mammography registries; the San Francisco Mammography Registry and the New Mexico Mammography Registry. Methods: Completeness of the Medicare data was assessed by comparing mammography use based on Medicare, with radiology reports from the mammography registries, which served as the referent standard. Capture rates for Medicare claims for individual mammograms were examined, and women were characterized as having undergone at least 1 mammogram within each 2-year period based on the Medicare data, and these rates were compared with the referent standard. To determine whether Medicare data can distinguish between screening and diagnostic mammography, we performed a classification analysis using the mammography registries screening/diagnostic designation as the referent standard (dependent variable) and Medicare claim information as the independent/predictor variable. On the basis of the mammogram level classification analysis, women were categorized as having been frequently screened (at least 2 screening mammograms spaced by 12 to 36 months), screened (at least 1 screening mammogram), or not screened. Subjects: Women ages 65 and older, diagnosed with breast cancer between 1992-1999, who had at least 1 mammogram between 1992-1999 were examined. Results: A total of 3340 mammograms were obtained in 1371 women between 1992 and 1999. Overall, 83% of mammograms obtained by these women had a corresponding billing claim in Medicare. This increased from 65% in 1992 to 90% in 1999. Of women who underwent at least 1 mammogram during each 2-year period per the referent standard, 94% of women were accurately classified by Medicare claims as also having undergone mammography during the same 2-year period. In multivariable analysis, a mammogram was more likely to be associated with a billing claim over time, for women 80 years or older, and for white and Asian as compared with Hispanic women. Neither socioeconomic status nor screening/diagnostic designation affected the likelihood that a mammogram would be associated with a billing claim. The Medicare data accurately categorized a given mammogram as screening or diagnostic for 87.5% of mammograms. Lastly, there was moderate to substantial agreement in the categorization of women as frequently screened, screened or not screened between the 2 data sets (weighted kappa 0.74, 95% confidence interval 0.70-0.78). Conclusion: Medicare administrative claims are reliable for assessment of mammography utilization and have become more accurate over time. Medicare claims data also provide a mechanism for designating mammography as screening or diagnostic, which subsequently may allow accurate description of a woman's screening history.

Purpose Physical inactivity is a well-known factor associated with an increased risk of breast cancer. However, there is a disparity in physical activity levels among women in the United States. These disparities are associated with differences in women’s mammography screening behaviors, which may contribute to disparities in breast cancer incidence and outcomes. This study aims to evaluate the association between physical activity and the utilization of mammography screening. It also assesses whether this association is modified by women’s race/ethnicity and age. Methods This is a longitudinal study that used the Health and Retirement Study data from 2004 to 2016. A total of 18,157 women aged 40 years and older were included. The 2004 wave was used as the baseline, with follow-up conducted in 2008, 2012, and 2016 (wave 9, 11, and 13 respectively). Mixed-effects logistic regression models were used, and odds ratios were reported. Results The study found a significant positive association between physical activity and mammography utilization. After adjusting for confounding variables, women who were physically active had 1.31 times the odds of undergoing mammography screening compared to those who were inactive (95% CI: 1.13–1.51, p  < 0.001). The association between physical activity and mammography screening utilization was weaker among Hispanic women. Conclusion Interventions encouraging physical activity targeting racial/ethnic minorities may contribute to increasing mammography screening utilization and reducing breast cancer disparity.

In France, mammography screening is offered to women aged between 50 and 74 years. EDIFICE, the iterative nationwide survey, collected data on a national level about consumers utilization of available cancer screening procedures. This analysis compared data from a subset of 241 women aged between 40 and 50 years with that of 488 women aged between 50 and 74 years. Multivariate analysis showed the following significant factors to be linked with screening attendance for women younger than 50 years: age, with a threshold value at 44 years; awareness of the recommended screening period (2 years); consultation within the last 12 months with a general practitioner or a gynaecologist; and long standing local programme for colon cancer screening. Notwithstanding the debate on risk/benefit of breast cancer screening for women in their 40s, we observed more differences with regard to attendance between women aged 40–45 years versus that of 46–74 years than between women aged 40–49 years versus that of 50–74 years. The issue that is unanswered as yet is, do women make a kind of heuristic for starting breast cancer screening, leading them to a threshold choice of 45 years or alternatively to a collective answer of standard age minus 5 years!

Analysis of data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) registries shows that the age-adjusted incidence of breast cancer in the United States fell sharply by 6.7% in 2003, as compared with the rate in 2002. The decrease began in mid-2002 and had begun to level off by mid-2003. The authors attribute the decline to a sharp drop in the use of postmenopausal hormone-replacement therapy. The age-adjusted incidence of breast cancer in the United States fell sharply by 6.7% in 2003. The authors attribute the decline to a sharp drop in the use of postmenopausal hormone-replacement therapy. Major changes in cancer incidence and death rates, as detected in cancer-registry data, provide unique opportunities to examine questions related to the cause, prevention, detection, and treatment of cancer. In a preliminary report, we suggested that such a major change in breast-cancer incidence occurred in 2003 in the United States. 1 In contrast, the 1990s saw an increase in the annual age-adjusted incidence of breast cancer by an average of about 0.5% per year, a rise that was particularly evident among women who were 50 years of age or older 2 (Figure 1). Changes in reproductive factors, in the use of menopausal . . .

Previous research has not examined barriers to mammography screening among Haitian immigrant women through their own discourse. Community Health Workers conducted in-depth interviews with Haitian women in Little Haiti, Miami. We used a grounded theory approach to analyze data from the in-depth interviews. Emergent themes coalesced into three core categories of screening barriers: Structural, Psychosocial, and Socio-Cultural. We developed a model of screening barriers to depict the themes within each core category. Screening barriers must be examined and understood from the social contexts in which they are produced in order to create meaningful interventions.

Seven statistical models were independently developed to investigate the reasons for the reduction in the rate of death from breast cancer from 1975 to 2000. All models led to the conclusion that both mammographic screening and adjuvant treatment have contributed to the decrease in mortality. Seven statistical models led to the conclusion that both mammographic screening and adjuvant treatment have contributed to the reduction in the rate of death from breast cancer from 1975 to 2000. The Cancer Intervention and Surveillance Modeling Network (CISNET) is a consortium of investigators sponsored by the National Cancer Institute whose purpose is to measure the effect of cancer-control interventions on the incidence of and risk of death from cancer in the general population. This report of the CISNET Breast Cancer Working Group provides estimates of the contributions of screening mammography and adjuvant treatment to the reduction in the rate of death from breast cancer among U.S. women from 1975 to 2000. In 1975, the rate of death from breast cancer among women 30 to 79 years of age, adjusted for . . .

Healthy People 2020 (HP2020) includes objectives to increase screening for breast, cervical, and colorectal cancer (1) as recommended by the U.S. Preventive Services Task Force (USPSTF).* Progress toward meeting these objectives is monitored by measuring cancer screening test use against national targets using data from the National Health Interview Survey (NHIS) (1). Analysis of 2015 NHIS data indicated that screening test use remains substantially below HP2020 targets for selected cancer screening tests. Although colorectal cancer screening test use increased from 2000 to 2015, no improvements in test use were observed for breast and cervical cancer screening. Disparities exist in screening test use by race/ethnicity, socioeconomic status, and health care access indicators. Increased measures to implement evidence-based interventions and conduct targeted outreach are needed if the HP2020 targets for cancer screening are to be achieved and the disparities in screening test use are to be reduced.

In this study of women between the ages of 65 and 69 years who were enrolled in Medicare managed-care plans from 2001 through 2004, enrollees were less likely to undergo screening mammography if their health plan charged patients a copayment. In this study of women between the ages of 65 and 69 years who were enrolled in Medicare managed-care plans, enrollees were less likely to undergo screening mammography if their health plan charged patients a copayment. Most Americans with health insurance are required to pay part of the cost of a physician visit, hospitalization, or other health service as an out-of-pocket expense. This financial responsibility, known as patient cost sharing, is designed to control health care spending because persons tend to use fewer health services when they are required to bear higher portions of the cost. 1 – 3 Payers and insurers have increased cost-sharing requirements in recent years. 4 Since 2001, the average deductible in employer-based plans has increased by 60%, and the most common copayment for an office visit has doubled. 5 A growing number of employers offer . . .