Skip directly to searchSkip directly to the site navigationSkip directly to this page's context menuSkip directly to the page's main content

Complete Indicator Report of Breast Cancer - Mammography

Definition

The proportion of women 40 years or older who reported having a mammogram in the last two years.

Numerator

The number of women 40 years or older who reported having a mammogram in the last two years.

Denominator

The total number of female survey respondents aged 40 or older excluding those who responded "don't know" or "refused" to the numerator question.

Data Interpretation Issues

To reduce bias and more accurately represent population data, the BRFSS has changed survey methodology. In 2010, it began conducting surveys by cellular phone in addition to landline phones. It also adopted "iterative proportional fitting" (raking) as its weighting method.

Why Is This Important?

Breast cancer is the most commonly occurring cancer in U.S. women (excluding basal and squamous cell skin cancers) and the leading cause of female cancer death in Utah. Deaths from breast cancer can be substantially reduced if the tumor is discovered at an early stage. Mammography is currently the best method for detecting cancer early. Clinical trials have demonstrated that routine screening with mammography can reduce breast cancer deaths by 20% to 30% in women aged 50 to 69 years (1-6), and by about 17% in women aged 40 to 49 years (7,8).

There is consensus that women aged 40 or older should undergo routine screening with mammography at least every two years. The American Cancer Society recommends that women aged 40 or older have an annual mammogram, while the National Cancer Institute, the U.S. Preventive Services Task Force, and the U.S. Department of Health and Human Services recommend that women 40 years or older undergo mammography every one to two years (9, 10, 11). Women who are at higher than average risk of breast cancer should seek expert medical advice about whether they should begin screening before age 40 and the frequency of that screening (10).

Healthy People Objective C-17:

Increase the proportion of women who receive a breast cancer screening based on the most recent guidelines
U.S. Target: 81.1 percent
State Target: 74.14 percent

Other Objectives

CSTE Chronic Disease Indicators

How Are We Doing?

Between 1989 and 2010, the percentage of Utah women aged 40 or older who reported receiving a mammogram within the last two years increased from 51.6 percent to 66.4 percent.

To reduce bias and more accurately represent population data, the BRFSS has changed survey methodology in 2010. It began conducting surveys by cellular phone in addition to landline phones. It also adopted "iterative proportional fitting" (raking) as its weighting method. Based on this methodology, Utah's rate in 2011 was 66.8%.

All additional indicator views are based on the new methodology.

Between 2010 and 2011, there was no significant difference in mammography screening rates among the different racial and ethnic groups. One local health district reported a slightly higher screening rate than the state (Summit Health District, 75.1 percent). After dividing the health districts into Utah Small Areas the prevalence of mammograms ranged from a high of 82.1 percent in Holladay to a low of 48.0 percent in South Salt Lake.

How Do We Compare With U.S.?

Nationally, the percentage of women aged 40 or older who reported receiving a mammogram in the past two years increased from 55.2 percent in 1989 to 74.9 percent in 2010. Since 1994, the percentage of Utah women aged 40 or older who reported receiving a mammogram has been below the U.S. rate. In 2010, 66.4 percent of Utah women aged 40 and older had received a mammogram in the last two years compared with 74.9 percent of U.S. women.

Since data for the new BRFSS methodology is not yet available nationally, the above comparison is based on previous methodology.

What Is Being Done?

The UDOH Utah Cancer Control Program (UCCP) distributes free mammography vouchers to women who receive a clinical breast exam at a UCCP sponsored clinic and meet age and income guidelines. The 2000 Utah legislature approved a resolution encouraging private health insurance companies and employers to include insurance coverage for the screening and detection of breast, colorectal, and prostate cancers.

In addition, the Utah Department of Health initiated the Utah Cancer Action Network (UCAN), a statewide partnership whose goal is to reduce the burden of cancer. The mission of the UCAN is to lower cancer incidence and mortality in Utah through collaborative efforts directed toward cancer prevention and control. As a result of this planning process, objectives and strategies have been developed by community partners regarding the early detection of cervical, testicular, prostate, skin, breast, and colorectal cancers as well as the promotion of physical activity, healthy eating habits, and smoking cessation.

Available Services

The Utah Cancer Control Program (UCCP) provides free to low cost clinical breast exams and mammograms to women who meet age and income guidelines. Eligible women with abnormal screening exams are offered diagnostic evaluation by participating providers. In addition, the UCCP provides education about the need for early detection and the availability of screening services, performs outreach to eligible women, uses an annual reminder system, collects outcome data and disseminates information about breast cancer. As of July 1, 2001, the UCCP is able to refer Utah women in need of treatment for breast and cervical cancers and precancerous lesions for full Medicaid benefits. The women must meet all requirements as outlined in the National Breast and Cervical Cancer Treatment Act.

Other Program Information

The UDOH Utah Cancer Control Program (UCCP) distributes free mammography vouchers to women who receive a clinical breast exam at a UCCP sponsored clinic and meet age and income guidelines. The 2000 Utah legislature approved a resolution encouraging private health insurance companies and employers to include insurance coverage for the screening and detection of breast, colorectal, and prostate cancers.



Related Indicators

Relevant Population Characteristics

Routine screening for breast cancer with mammography has been identified as a priority issue for women 40 years of age or older by several scientific organizations.

Related Relevant Population Characteristics Indicator Reports:


Health Care System Factors

According to data collected by the Utah Behavioral Risk Factor Surveillance System, use of mammography is lower among women without health insurance compared to women with health insurance. Mammography is a preventive service covered by Medicare.

Related Health Care System Factors Indicator Reports:


Risk Factors

The most important risk factor for breast cancer is increasing age. Other established risk factors include personal or family history of breast cancer, history of abnormal breast biopsy, genetic alterations, early age at onset of menses, late age at onset of menopause, never having children or having a first live birth at age 30 or older, and history of exposure to high dose radiation. Associations have also been suggested between breast cancer and oral contraceptives, long-term use of hormone replacement therapy, obesity (in post-menopausal women), alcohol, and a diet high in fat. Some studies suggest that exercise in youth might give life-long protection against breast cancer and that even moderate physical activity as an adult could lower breast cancer risk. More research is needed to confirm these findings.

Related Risk Factors Indicator Reports:


Health Status Outcomes

Routine screening with mammography is an important tool in the early detection of breast cancer and early detection can save lives.

Related Health Status Outcomes Indicator Reports:




Graphical Data Views

Mammogram Within the Past Two Years, Utah and U.S., 1989-2000, 2002, 2004, 2006, 2007, 2008, 2010, and 2011

::chart - missing::

Geog: BRFSS Utah vs. U.S. Year Percentage of Women Age 40+ Lower Limit Upper Limit
UT Old Methodology 1989 51.6% 46.6% 56.5%
UT Old Methodology 1990 54.8% 50.0% 59.5%
UT Old Methodology 1991 57.9% 53.1% 62.8%
UT Old Methodology 1992 64.0% 59.7% 68.3%
UT Old Methodology 1993 61.6% 56.9% 66.2%
UT Old Methodology 1994 67.4% 62.7% 72.0%
UT Old Methodology 1995 63.1% 58.9% 67.3%
UT Old Methodology 1996 64.4% 60.7% 68.2%
UT Old Methodology 1997 65.0% 60.7% 69.3%
UT Old Methodology 1998 65.7% 61.3% 70.1%
UT Old Methodology 1999 67.3% 63.3% 71.3%
UT Old Methodology 2000 72.6% 68.9% 76.3%
UT Old Methodology 2002 68.8% 65.5% 72.0%
UT Old Methodology 2004 66.4% 63.7% 69.1%
UT Old Methodology 2006 67.8% 65.3% 70.2%
UT Old Methodology 2007 67.3% 64.6% 69.9%
UT Old Methodology 2008 67.2% 64.5% 69.8%
UT Old Methodology 2010 66.4% 64.5% 68.2%
US Old Methodology 1989 55.2% 54.1% 56.3%
US Old Methodology 1990 58.8% 57.7% 59.8%
US Old Methodology 1991 63.2% 62.3% 64.1%
US Old Methodology 1992 63.5% 62.7% 64.3%
US Old Methodology 1993 66.8% 56.9% 66.2%
US Old Methodology 1994 66.8% 66.0% 67.5%
US Old Methodology 1995 69.8% 69.0% 70.5%
US Old Methodology 1996 70.0% 69.3% 70.6%
US Old Methodology 1997 71.1% 70.4% 71.7%
US Old Methodology 1998 72.3% 71.0% 73.7%
US Old Methodology 1999 74.1% 73.5% 74.6%
US Old Methodology 2000 76.6% 76.0% 77.1%
US Old Methodology 2002 76.0% 75.4% 76.5%
US Old Methodology 2004 74.2% 73.8% 74.7%
US Old Methodology 2006 76.1% 75.7% 76.6%
US Old Methodology 2008 76.2% 75.9% 76.6%
US Old Methodology 2010 74.9% 74.5% 75.2%
UT New Methodology 2010 64.5% 62.6% 66.3%
UT New Methodology 2011 66.8% 64.0% 69.5%
Record Count: 37

Data Notes

Age-adjusted to U.S. 2000 standard population. UT/US Old Methodology: Previous BRFSS methodology used "post-stratification" which was used to weight data by age, gender, and local health district (LHD). UT New Methodology: To reduce bias and more accurately represent population data, the BRFSS has changed survey methodology. It began conducting surveys by cellular phone in addition to landline phones. It also adopted "iterative proportional fitting" (raking) as its weighting method. With raking, education, race/ethnicity, marital status, home ownership/renter, and telephone source are included in the weighting procedure.

Data Sources

Utah Data: Behavioral Risk Factor Surveillance System, Office of Public Health Assessment, Utah Department of Health. U.S. Data: Behavioral Risk Factor Surveillance System (BRFSS), Division of Behavioral Surveillance, CDC Office of Surveillance, Epidemiology, and Laboratory Services.



Mammogram Within the Past Two Years by Local Health District, Utah, 2010-2011

::chart - missing::

Local Health District Age-adjusted Percentage of Women Age 40+ Lower Limit Upper Limit
Bear River 65.7% 59.0% 71.7%
Central 55.4% 48.1% 62.5%
Davis County 67.0% 62.0% 71.6%
Salt Lake County 64.8% 62.0% 67.6%
Southeastern 64.6% 57.5% 71.1%
Southwest 65.6% 57.4% 72.9%
Summit 75.1% 67.7% 81.2%
Tooele 55.7% 49.0% 62.2%
TriCounty 57.2% 49.4% 64.7%
Utah County 65.2% 60.9% 69.2%
Wasatch 68.5% 61.2% 75.0%
Weber-Morgan 69.4% 64.0% 74.4%
State 65.5% 63.9% 67.1%
Record Count: 13

Data Notes

Age-adjusted to the U.S. 2000 standard population.

Data Sources

Utah Data: Behavioral Risk Factor Surveillance System, Office of Public Health Assessment, Utah Department of Health.



Mammogram Within the Past Two Years by Utah Small Area, 2010-2011

::chart - missing::

Utah Small Areas Age-adjusted Percentage of Women Age 40+ Lower Limit Upper Limit Note
Brigham City 58.4% 45.8% 70.0%
Other Box Elder Co. 54.4% 38.4% 69.6%
Logan 76.1% 64.6% 84.7%
Other Cache/Rich Co. 68.1% 57.2% 77.4%
Ben Lomond 66.7% 54.6% 77.0%
Morgan/East Weber Co. 73.6% 62.6% 82.3%
Downtown Ogden 63.0% 49.6% 74.8%
South Ogden 73.3% 60.4% 83.2%
Roy/Hooper 61.2% 47.2% 73.6%
Riverdale 79.2% 64.7% 88.8%
Clearfield/Hill AFB 58.5% 45.3% 70.6%
Layton 60.4% 49.2% 70.5%
Syracuse/Kaysville 75.2% 65.0% 83.3%
Farmington/Centerville 77.1% 64.3% 86.3%
Woods Cross/North SL 57.2% 43.1% 70.3%
Bountiful 67.0% 55.5% 76.8%
Rose Park 50.7% 35.7% 65.5%
Avenues 65.4% 44.2% 81.8%
Foothill/U of U 81.0% 64.7% 90.9% *
Magna 58.2% 42.4% 72.4%
Glendale 39.1% 22.1% 59.3%
West Valley West 62.3% 52.0% 71.6%
West Valley East 53.7% 41.1% 65.9%
Downtown Salt Lake 57.3% 44.4% 69.2%
South Salt Lake 48.0% 31.9% 64.5%
Millcreek 66.4% 55.6% 75.8%
Holladay 82.1% 72.6% 88.8%
Cottonwood 72.0% 60.4% 81.4%
Kearns 48.1% 35.2% 61.3%
Taylorsville 76.2% 64.7% 84.8%
Murray 59.6% 46.4% 71.5%
Midvale 65.4% 50.6% 77.8%
W. Jordan Northeast 58.1% 41.6% 73.0%
W. Jordan Southeast 75.0% 60.9% 85.2%
W. Jordan West, Copperton 72.8% 57.6% 84.1%
South Jordan 77.4% 67.8% 84.7%
Sandy Center 57.9% 47.0% 68.1%
Sandy, Northeast 65.1% 48.6% 78.6%
Sandy, Southeast 76.5% 63.9% 85.7%
Riverton/Draper 66.9% 57.9% 74.8%
Tooele Co. 56.0% 49.3% 62.5%
Lehi/Cedar Valley 53.3% 40.0% 66.1%
American Fork/Alpine 62.3% 50.7% 72.6%
Pleasant Grove/Lindon 61.7% 49.7% 72.4%
North Orem 69.6% 52.5% 82.6%
West Orem 66.7% 47.4% 81.7%
East Orem 78.6% 64.5% 88.1%
Provo/BYU 70.7% 54.6% 82.9%
Provo South 59.2% 43.0% 73.7%
Springville/Spanish Fork 71.8% 62.0% 79.8%
Utah Co. South 57.3% 42.9% 70.5%
Summit Co. 76.1% 68.9% 82.1%
Wasatch Co. 67.9% 60.2% 74.7%
TriCounty LHD 60.1% 51.9% 67.8%
Juab/Millard/Sanpete Co. 51.2% 42.6% 59.7%
Sevier/Piute/Wayne Co. 66.8% 53.9% 77.7%
Carbon/Emery Co. 66.6% 58.0% 74.1%
Grand/San Juan Co. 54.9% 42.8% 66.4%
St. George 64.9% 49.3% 77.9%
Other Washington Co. 62.8% 49.9% 74.2%
Cedar City 66.3% 47.8% 80.8%
Other Southwest 54.2% 35.7% 71.7%
State 65.5% 63.9% 69.1%
Record Count: 63

Data Notes

Age-adjusted to U.S. 2000 standard population. A description of the Utah Small Areas may be found on IBIS at the following URL: http://ibis.health.utah.gov/query/Help.html. *Use caution when interpreting rate for Foothill/U of U, the estimate does not meet UDOH standards for reliability.

Data Sources

Utah Data: Behavioral Risk Factor Surveillance System, Office of Public Health Assessment, Utah Department of Health.



Mammogram Within the Past Two Years by Ethnicity, Utah, 2010 and 2011

::chart - missing::

Hispanic Ethnicity Percentage of Women Age 40+ Lower Limit Upper Limit
Hispanic 57.3% 49.8% 64.5%
Non-Hispanic 66.2% 64.5% 67.8%
All Utahns 65.5% 63.9% 67.1%
Record Count: 3

Data Notes

Age-adjusted to the U.S. 2000 standard population.

Data Sources

Utah Data: Behavioral Risk Factor Surveillance System, Office of Public Health Assessment, Utah Department of Health.



Mammogram Within the Past Two Years by Race, Utah, 2010 and 2011

::chart - missing::

Race Percentage of Women Age 40+ Lower Limit Upper Limit Note
American Indian/Native Alaskan 56.4% 42.8% 69.1%
Asian 79.7% 30.8% 89.4% *
Black 74.4% 52.3% 88.5% *
Pacific Islander 50.4% 27.9% 72.8%
White 65.8% 64.1% 67.5%
Record Count: 5

Data Notes

Age-adjusted to the U.S. 2000 standard population. *Use caution in interpreting rates for Asian and Black, the estimate has a relative standard error greater than 30% and does not meet UDOH standards for reliability.

Data Sources

Utah Data: Behavioral Risk Factor Surveillance System, Office of Public Health Assessment, Utah Department of Health.



Mammogram Within the Past Two Years by Education, Utah, 2010-2011

::chart - missing::

Education Level Percentage of Women Age 40+ Lower Limit Upper Limit
Less Than High School 46.9% 39.6% 54.4%
H.S. Grad or G.E.D. 65.6% 62.4% 68.7%
Some Post High School 65.5% 62.8% 68.1%
College Graduate 70.9% 68.2% 73.4%
Total 65.5% 63.9% 67.1%
Record Count: 5

Data Notes

Age-adjusted to U.S. 2000 standard population.

Data Sources

Utah Data: Behavioral Risk Factor Surveillance System, Office of Public Health Assessment, Utah Department of Health.



Mammogram Within the Past Two Years by Income, Utah, 2010-2011

::chart - missing::

Income Category Percentage of Women Age 40+ Lower Limit Upper Limit
<$25,000 52.3% 48.2% 56.4%
$25,000-$49,999 61.1% 57.3% 64.8%
$50,000-$74,999 73.2% 69.6% 76.7%
$75,000+ 74.3% 70.6% 77.6%
Total 65.5% 63.9% 67.1%
Record Count: 5

Data Notes

Age-adjusted to U.S. 2000 standard population.

Data Sources

Utah Data: Behavioral Risk Factor Surveillance System, Office of Public Health Assessment, Utah Department of Health.


References and Community Resources

Utah Cancer Control Program @ www.cancerutah.org
Utah Cancer Action Network @ www.ucan.cc
Susan G. Komen Foundation @ www.komen.org
National Cancer Institute @ www.cancer.gov
American Cancer Society @ www.cancer.org
Huntsman Cancer Institute @ www.huntsmancancer.org
Centers for Disease Control and Prevention @ www.cdc.gov
American Society of Clinical Oncology @ www.asco.org

References:

1. Tabar L, Fagerberg G, Duffy SW, et al. Update of the Swedish two-county program of mammographic screening for breast cancer. Radiol Clin North Am 1992;30:187-210.

2. Roberts MM, Alexander FE, Anderson TJ, et al. Edinburgh trial of screening for breast cancer: mortality at seven years. Lancet 1990;335:241-246.

3. Shapiro S, Venet W, Strax P, et al, eds. Periodic screening for breast cancer. Baltimore: Johns Hopkins University Press, 1988.

4. Andersson I, Aspegren K, Janzon L, et al. Mammographic screening and mortality from breast cancer: the Malmo mammographic screening trial. BMJ 988;297:943-948.

5. Frisell J, Eklund G, Hellstrom L, et al. Randomized study of mammography
screening-preliminary report on mortality in the Stockholm trial. Breast Cancer Res Treat 1991;18:49-56.

6. Nystrom L, Rutqvist LE, Wall S, et al. Breast cancer screening with mammography: overview of Swedish randomized trials. Lancet 1993;341:973-978.

7. National Institutes of Health Consensus Development Panel: National Institutes of Health Consensus Development Conference Statement: breast cancer screening for women ages 40-49, January 21-23, 1007, Journal of the National Cancer Institute 89 (14):1015-1026, 1997.

8. National Cancer Advisory Board: National Cancer Advisory Board mammography recommendations for women ages 40-49, Bethesda, Maryland, National Cancer Advisory Board, 1997.

9. American Cancer Society. (2001). Cancer Facts & Figures 2001. Atlanta, GA: author.

10. NCI Statement on Mammography Screening, Press Release, January 31, 2002, updated February 21, 2002. National Cancer Institute, Bethesda, MD. wysiwyg://13http://newscenter.cancer.gov/pressreleases/mammstatement31jan02.html

11. HHS Affirms Value of Mammography for Detecting Breast Cancer, Press Release, February 21, 2002. U.S. Department of Health and Human Services, Washington, D.C. http://www.hhs.gov/news/press/2002pres/20020221.html

More information on the Behavioral Risk Factor Surveillance System may be found on the website of the Centers for Disease Control and Prevention - http://www.cdc.gov/brfss/

More Resources and Links

Evidence-based community health improvement ideas and interventions may be found at the following sites:

Additional indicator data by state and county may be found on these Websites:

Medical literature can be queried at the PubMed website.

For an on-line medical dictionary, click on this Dictionary link.

Page Content Updated On 11/29/2012, Published on 04/08/2013
Cancer Control Program, Bureau of Health Promotion, Division of Disease Control and Prevention, Utah Department of Health, Salt Lake City, UT 84114-2107, Telephone: 801-538-6712, Fax: 801-538-9495, Website: www.cancerutah.org, www.ucan.cc, Contact: Kathryn Rowley
The information provided above is from the Utah Department of Health's Center for Health Data IBIS-PH web site (http://ibis.health.utah.gov). The information published on this website may be reproduced without permission. Please use the following citation: "Retrieved Sun, 19 May 2013 3:16:37 from Utah Department of Health, Center for Health Data, Indicator-Based Information System for Public Health Web site: http://ibis.health.utah.gov".

Content updated: Sun, 19 May 2013 3:16:37