Date of Award

January 2014

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Anees Chagpar

Subject Area(s)

Medicine

Abstract

Screening mammography among women with a family history of breast cancer

Lauren Hibler, Anees Chagpar

Women with a first degree family history of breast cancer are at increased risk of developing this disease. Screening with mammography has been demonstrated to detect cancer early, when it is most treatable. We hypothesized that, due to their increased risk, women with a first degree family history of breast cancer would be more likely to obtain screening mammograms than the general population. We further sought to determine the self-reported reasons for failing to adhere to screening guidelines in this high risk population.

The National Health Interview Survey (NHIS), conducted annually by the Centers for Disease Control, is designed to be representative of the US population. The 2010 NHIS Cancer Supplement was used to evaluate the rates of mammography, predictors of screening, and the most common reasons cited for not having a mammogram, in the previous two years in women with and without a first degree family history of breast cancer.

Overall, 78.5% of women reported obtaining a screening mammogram in the previous two years. Women with a first degree family history had similar rates of screening mammography as average risk women. (79.5% vs 78.4% p=0.452). On multivariate analyses, income to poverty line ratio, and access to preventive health care services were independently associated with screening mammography in both average and high risk cohorts. The reasons women overall cited for not obtaining a screening mammogram (irrespective of risk cohort) were: "Never thought about it," "Doctor didn't say I needed it," and "Too expensive, or Didn't have insurance."

These data demonstrate that high risk populations are not more likely to adhere to screening guidelines for breast cancer than their average risk counterparts, and that the main factors influencing adherence were income, insurance, and access to preventive health services. These findings suggest that social determinants of health affect screening, and addressing key issues such as access and cost of healthcare is critical to improving rates of screening mammography, especially in high risk groups.

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This is an Open Access Thesis.

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