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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. More details about these changes can be found at: http://health.utah.gov/opha/publications/brfss/Raking/Raking%20impact%202011.pdf.

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, and by about 17% in women aged 40 to 49 years.

The U.S. Preventive Services Task Force recommends that women 50-74 years of age undergo mammography every one to two years, while the American Cancer Society recommends that women aged 40 or older have an annual mammogram. 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.

If you are 40 or over, talk to your doctor about which recommendations are best for you.

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 2011-2013 was 66.9 percent (age-adjusted rate).

All additional indicator views are based on the new methodology.

Between 2011 and 2013, there were no significant differences in mammography screening rates among different ethnic groups. Asians were significantly more likely to be screened (82.2 percent). There were no other significant differences among races.

Two local health districts reported significantly higher screening rates than the state (Summit, 75.8 percent and Weber-Morgan, 73.3 percent), while three local health districts reported significantly lower screening rates when compared to the state (Central, 59.9 percent; Southeastern Utah, 58.0 percent; TriCounty, 54.9 percent).

After dividing the health districts into Utah Small Areas the prevalence of mammograms ranged from a high of 82.3 percent in Riverdale to a low of 40.5 percent in Grand/San Juan.

Between 2011 and 2013, Utah women 40 to 49 years of age were significantly less likely to have received a mammogram within the past two years than older women (59.3 percent vs 72.6 percent among women 50-64 and 70.0 percent among women 65 and over).

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 2012, based on new methodology, 67.8 percent of Utah women aged 40 and older had received a mammogram in the last two years compared with 74.0 percent of U.S. women.

What Is Being Done?

The Utah Cancer Control Program (UCCP) in the Utah Department of Health (UDOH) 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 UDOH 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 Indicators:


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 Indicators:


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 Indicators:


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 Indicators:




Graphical Data Views

Mammogram Within the Past Two Years, Utah and U.S., 1989-2013

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BRFSS Utah vs. U.S. Year Age-adjusted Percentage of Women Age 40+ Lower Limit Upper Limit
Record Count: 40
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%
UT New Methodology 2012 67.8% 66.0% 69.5%
UT New Methodology 2013 65.8% 63.1% 68.5%
US New Methodology 2012 74.0%

Data Notes

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

Data provided for all years available.

Old Methodology: Previous BRFSS methodology used "post-stratification" which was used to weight data by age, gender, and local health district (LHD).

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, 2011-2013

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confidence limits

Local Health District Age-adjusted Percentage of Women Age 40+ Lower Limit Upper Limit
Record Count: 13
Bear River 68.1% 62.5% 73.2%
Central 59.9% 53.3% 66.1%
Davis County 70.9% 66.6% 74.9%
Salt Lake County 65.9% 63.4% 68.2%
Southeastern 58.0% 51.4% 64.4%
Southwest 69.2% 63.1% 74.6%
Summit 75.8% 68.9% 81.6%
Tooele 64.1% 57.5% 70.3%
TriCounty 54.9% 47.1% 62.5%
Utah County 66.1% 62.4% 69.6%
Wasatch 70.5% 63.2% 76.9%
Weber-Morgan 73.3% 68.7% 77.4%
State 66.9% 65.5% 68.3%

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 Utah Small Area, 2011-2013

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confidence limits

Utah Small Areas Age-adjusted Percentage of Women Age 40+ Lower Limit Upper Limit Note
Record Count: 67
Brigham City 60.3% 48.3% 71.2%
Box Elder Co (Other) 65.6% 50.8% 77.8%
Logan 76.7% 67.9% 83.7%
Cache Co (Oth)/Rich Co (All) 66.1% 56.7% 74.4%
Ben Lomond 72.9% 62.8% 81.0%
Morgan Co (All)/Weber Co (E) 78.5% 69.9% 85.2%
Ogden (Downtown) 60.7% 49.0% 71.3%
South Ogden 66.9% 54.2% 77.6%
Roy/Hooper 70.0% 58.6% 79.4%
Riverdale 82.3% 71.5% 89.6%
Clearfield/Hill AFB 66.3% 56.6% 74.8%
Layton 69.8% 59.2% 78.6%
Syracuse/Kaysville 78.1% 69.4% 84.8%
Farmington/Centerville 71.5% 60.5% 80.4%
Woods Cross/North Salt Lake 61.5% 47.8% 73.6%
Bountiful 74.5% 62.4% 83.8%
SLC (Rose Park) 54.0% 40.4% 67.1%
SLC (Avenues) 61.5% 45.7% 75.1%
SLC (Foothill/U of U) 70.5% 56.6% 81.5%
Magna 65.4% 49.2% 78.7%
SLC (Glendale) 40.8% 26.3% 57.0%
West Valley (West) 63.4% 54.1% 71.8%
West Valley (East) 60.4% 41.4% 76.6% ^
West Valley (East) V2 65.9% 51.2% 78.0% ^^
SLC (Downtown) 52.4% 40.5% 64.1%
South Salt Lake 56.9% 41.1% 71.3%
Millcreek 74.6% 65.3% 82.1%
Holladay 81.5% 71.5% 88.5%
Cottonwood 71.6% 61.7% 79.8%
Kearns 55.7% 35.4% 74.2% ^
Kearns V2 52.6% 39.4% 65.4% ^^
Taylorsville (E)/Murray (W) 75.9% 64.8% 84.3%
Taylorsville (West) 66.2% 50.8% 78.8% ^^
Murray 74.1% 62.9% 82.8%
Midvale 67.1% 55.6% 76.8%
West Jordan (NE) 57.2% 33.8% 77.8% ^
West Jordan (NE) V2 65.7% 51.1% 77.8% ^^
West Jordan (SE) 70.7% 59.0% 80.2%
West Jordan (W)/Copperton 76.0% 64.0% 85.0%
South Jordan 73.5% 63.8% 81.4%
Sandy (Center) 58.5% 49.0% 67.3%
Sandy (NE) 58.5% 45.9% 70.0%
Sandy (SE) 75.3% 63.8% 84.0%
Riverton/Draper 64.8% 57.8% 71.3%
Tooele Co 63.9% 57.3% 70.0%
Lehi/Cedar Valley 48.0% 36.9% 59.4%
American Fork/Alpine 65.0% 53.9% 74.8%
Pleasant Grove/Lindon 67.6% 58.0% 75.9%
Orem (North) 68.6% 52.8% 81.1%
Orem (West) 72.3% 57.5% 83.4%
Orem (East) 74.3% 61.7% 83.9%
Provo (North)/BYU 68.9% 53.0% 81.3%
Provo (South) 69.8% 53.1% 83.4%
Springville/Spanish Fork 68.3% 59.6% 75.9%
Utah Co (South) 65.0% 53.4% 75.2%
Summit Co 76.5% 69.9% 82.1%
Wasatch Co 70.7% 63.2% 77.2%
TriCounty LHD 55.3% 47.4% 62.8%
Juab/Millard/Sanpete Co 53.6% 45.4% 61.0%
Sevier/Piute/Wayne Co 76.6% 67.8% 83.7%
Carbon/Emery Co 65.6% 57.3% 73.0%
Grand/San Juan Co 40.5% 30.3% 51.6%
St George 66.5% 53.4% 77.5%
Washington Co (Other) 69.2% 60.2% 77.0%
Cedar City 65.0% 51.1% 76.7%
Southwest LHD (Other) 71.1% 58.3% 81.2%
State 66.9% 65.5% 68.3%

Data Notes

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

^Due to Utah Small Area reclassification, these numbers only include data for 2011.

^^Due to Utah Small Area reclassification, these numbers only include data for 2012-2013.

A description of the Utah Small Areas may be found on IBIS at the following URL: http://ibis.health.utah.gov/query/Help.html.

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, 2011-2013

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confidence limits

Hispanic Ethnicity Age-adjusted Percentage of Women Age 40+ Lower Limit Upper Limit
Record Count: 3
Hispanic 61.8% 55.4% 67.8%
Non-Hispanic 67.2% 65.8% 68.6%
All Utahns 66.9% 65.5% 68.3%

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, 2011-2013

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confidence limits

Race Age-adjusted Percentage of Women Age 40+ Lower Limit Upper Limit Note
Record Count: 6
American Indian/Native Alaskan 54.8% 39.8% 68.9%
Asian 82.2% 72.0% 89.2%
Black 75.2% 60.3% 85.8%
Pacific Islander 46.9% 21.1% 74.5% *
White 66.8% 65.3% 68.2%
All Races 66.9% 65.5% 68.3%

Data Notes

Age-adjusted to the U.S. 2000 standard population. *Insufficient number of cases to meet UDOH standard for data reliability, interpret with caution.

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, 2011-2013

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confidence limits

Education Level Age-adjusted Percentage of Women Age 40+ Lower Limit Upper Limit
Record Count: 5
Less Than High School 56.2% 49.4% 62.8%
H.S. Grad or G.E.D. 66.3% 63.4% 69.0%
Some Post High School 66.5% 64.2% 68.7%
College Graduate 71.7% 69.4% 73.8%
Total 66.9% 65.5% 68.3%

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, 2011-2013

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confidence limits

Income Category Age-adjusted Percentage of Women Age 40+ Lower Limit Upper Limit
Record Count: 5
<$25,000 56.4% 52.7% 60.0%
$25,000-$49,999 63.0% 59.7% 66.2%
$50,000-$74,999 70.0% 66.6% 73.3%
$75,000+ 74.7% 71.6% 77.6%
Total 66.9% 65.5% 68.3%

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 Age Group, Utah, 2011-2013

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confidence limits

Age Group Percentage of Women Lower Limit Upper Limit
Record Count: 3
Age 40-49 59.3% 56.4% 62.1%
Age 50-64 72.6% 70.6% 74.5%
Age 65+ 70.0% 67.8% 72.1%

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 11/03/2014, Published on 12/02/2014
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 Thu, 18 December 2014 1:27:57 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: Tue, 2 Dec 2014 10:43:16 MST