Utilization of Screening Mammography in Women Before 50: Cross-Sectional Survey Results from the National Health Interview Survey

Objective: While the American College of Radiology recommends annual screening mammography starting at age 40 years, the US Pre-ventive Services Task Force (USPSTF) recommends that screening mammography in women younger than age 50 years should involve shared-decision making (SDM) between clinicians and patients, considering benefits and potential harms in younger women. Using a nationally representative cross-sectional survey, we aimed to evaluate patient-reported reasons and predictors of screening mammogra-phy utilization in this age group.Methods: Respondents aged 40-49 years from the 2018 National Health Interview Survey (NHIS) without a history of breast cancer were included (response rate 64%). Participants reported sociodemographic variables and reasons they did not engage in mammography screen-ing within the last two years. Multiple variable logistic regression analyses were performed to evaluate the association between sociodemo-graphic characteristics and patient-reported screening mammography use, accounting for complex survey sampling design elements.Results: 1,948 women between the ages of 40-49 years were included. Of this group, (758/1948) 46.6% reported receiving a screening mammogram within the last year, and 1196/1948 (61.4%) reported receiving a screening mammogram within the last two years. The most common reasons for not undergoing screening included: No reason/never thought about it 744/1948 (38.2%), Put it off 343/1948 (17.6%), Didn't need it 331/1948 (16.9%), Doctor didn't order it 162/1948 (8.3%), and I'm too young 63/1948 (5.3%). Multiple vari-able analyses demonstrated that lack of health insurance was the strongest predictor of mammography non-engagement (p< 0.001).Conclusion: Deficits in shared-decision-making in women younger than 50 years related to mammography utilization exist. Radiologists may be key in addressing this issue among ambulatory care providers and patients, educating about the benefits and harms of screening younger women, particularly in racial/ethnic minorities and uninsured patients, who experience additional barriers to care and SDM dis-cussions.

Automated summary

A nationally representative cross-sectional survey was conducted to explore the reasons and predictors of mammography utilization among women aged 40-49 years. The survey revealed that 46.6% of women had a screening mammogram in the past year, and 61.4% had one in the past two years. The most common reasons for not undergoing screening included lack of awareness, procrastination, perceived lack of need, no doctor's recommendation, and feeling too young. Lack of health insurance was found to be the strongest predictor of mammography non-engagement.