Breast Cancer Screening Among Adult Women — Behavioral Risk Factor Surveillance System, United States, 2010

Supplements
June 15, 2012 / 61(02);46-50

Jacqueline W. Miller, MD

Jessica B. King, MPH

Djenaba A. Joseph, MD

Lisa C. Richardson, MD

Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion

Corresponding author: Jacqueline W. Miller, MD, National Center for Chronic Disease Prevention and Health Promotion, CDC, 2858 Woodcock Boulevard, MS K-57, Atlanta, GA 30341. Telephone: 770-488-5061; Fax: 770-488-3230; E-mail: aci8@cdc.gov.

Introduction

Breast cancer continues to have a substantial impact on the health of women in the United States. It is the most commonly diagnosed cancer (excluding skin cancers) among women, with more than 210,000 new cases diagnosed in 2008 (the most recent year for which data are available) (1). Incidence rates are highest among white women at 122.6 per 100,000, followed by blacks at 118 per 100,000, Hispanics at 92.8, Asian/Pacific Islanders at 87.9, and American Indian/Alaskan Natives at 65.6 (1). Although deaths from breast cancer have been declining in recent years (2,3), it has remained the second leading cause of cancer deaths for women since the late 1980s with >40,000 deaths reported in 2008 (1). Although white women are more likely to receive a diagnosis of breast cancer, black women are more likely to die from breast cancer than women of any other racial/ethnic group (1). In addition, studies have demonstrated that nonwhite minority women tend to have a more advanced stage of disease at the time of diagnosis (4,5). Breast cancer also occurs more often among women aged ≥50 years, those with first-degree family members with breast cancer, and those who have certain genetic mutations (4,5). Understanding who is at risk for breast cancer helps inform guidelines for who should get screened for breast cancer.
In 2002, the U.S. Preventive Services Task Force (USPSTF) recommended screening mammography, with or without a clinical breast exam, every 1–2 years for women aged ≥40 years (6). Mammography has been demonstrated to reduce breast cancer mortality by detecting breast cancer early, when treatment is most effective (7,8). Mammography use increased in the 1990s, when it became a widely accepted practice for decreasing breast cancer mortality, but its use decreased during 2000–2005 (9,10). Studies that assessed this decline noted that women with insurance and higher annual incomes had the highest decrease in mammography use. In a follow up study, the overall prevalence of receiving mammography within the past 2 years rose slightly in 2006 to approximately the 2000 level (11). The latest report using 2008 data indicated that mammography use among women aged 50–74 years has essentially leveled off since 2000 (12). During 2000– 2006, although non-Hispanic white women and those with insurance had a substantial overall decline in mammography use, women who were uninsured, those who had lower annual income or education levels, and members of certain minority racial/ethnic groups persistently reported lower prevalence of mammography use (11,12). Moreover, substantial geographic variation in screening rates exists across the United States (13).
In November 2009, USPSTF changed its breast cancer screening recommendations to biennial mammography for women aged 50–74 years and stated that women aged 40–49 years do not need to be screened routinely (6). However, the Patient Protection and Affordable Care Act of 2010 (as amended by the Healthcare and Education Reconciliation Act of 2010 and referred to collectively as the Affordable Care Act [ACA]) specifically designates coverage of the breast cancer screening according to the recommendations issued before November 2009 (ACA §2713) (14).
This report summarizes the 2010 national mammography use prevalence estimates for women aged ≥40 years, by demographic characteristics and state-level prevalence estimates, based on the 2002 USPSTF recommendations. This information can be used by providers, public health practitioners, and other stakeholders as baseline data for assessing progress and gaps in breast cancer screening as the Affordable Care Act is implemented.