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Complete Health Indicator Report of Breast Cancer Screening (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 the 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.

Health 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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confidence limits

BRFSS Utah vs. U.S.YearAge-adjusted Percentage of Women Age 40+Lower LimitUpper Limit
Record Count: 40
UT Old Methodology198951.6%46.6%56.5%
UT Old Methodology199054.8%50.0%59.5%
UT Old Methodology199157.9%53.1%62.8%
UT Old Methodology199264.0%59.7%68.3%
UT Old Methodology199361.6%56.9%66.2%
UT Old Methodology199467.4%62.7%72.0%
UT Old Methodology199563.1%58.9%67.3%
UT Old Methodology199664.4%60.7%68.2%
UT Old Methodology199765.0%60.7%69.3%
UT Old Methodology199865.7%61.3%70.1%
UT Old Methodology199967.3%63.3%71.3%
UT Old Methodology200072.6%68.9%76.3%
UT Old Methodology200268.8%65.5%72.0%
UT Old Methodology200466.4%63.7%69.1%
UT Old Methodology200667.8%65.3%70.2%
UT Old Methodology200767.3%64.6%69.9%
UT Old Methodology200867.2%64.5%69.8%
UT Old Methodology201066.4%64.5%68.2%
US Old Methodology198955.2%54.1%56.3%
US Old Methodology199058.8%57.7%59.8%
US Old Methodology199163.2%62.3%64.1%
US Old Methodology199263.5%62.7%64.3%
US Old Methodology199366.8%56.9%66.2%
US Old Methodology199466.8%66.0%67.5%
US Old Methodology199569.8%69.0%70.5%
US Old Methodology199670.0%69.3%70.6%
US Old Methodology199771.1%70.4%71.7%
US Old Methodology199872.3%71.0%73.7%
US Old Methodology199974.1%73.5%74.6%
US Old Methodology200076.6%76.0%77.1%
US Old Methodology200276.0%75.4%76.5%
US Old Methodology200474.2%73.8%74.7%
US Old Methodology200676.1%75.7%76.6%
US Old Methodology200876.2%75.9%76.6%
US Old Methodology201074.9%74.5%75.2%
UT New Methodology201064.5%62.6%66.3%
UT New Methodology201166.8%64.0%69.5%
UT New Methodology201267.8%66.0%69.5%
UT New Methodology201365.8%63.1%68.5%
US New Methodology201274.0%

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 DistrictAge-adjusted Percentage of Women Age 40+Lower LimitUpper Limit
Record Count: 13
Bear River68.1%62.5%73.2%
Central59.9%53.3%66.1%
Davis County70.9%66.6%74.9%
Salt Lake County65.9%63.4%68.2%
Southeast58.0%51.4%64.4%
Southwest69.2%63.1%74.6%
Summit75.8%68.9%81.6%
Tooele64.1%57.5%70.3%
TriCounty54.9%47.1%62.5%
Utah County66.1%62.4%69.6%
Wasatch70.5%63.2%76.9%
Weber-Morgan73.3%68.7%77.4%
State66.9%65.5%68.3%

Data Notes

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

Data Source

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 AreasAge-adjusted Percentage of Women Age 40+Lower LimitUpper LimitNote
Record Count: 67
Brigham City60.3%48.3%71.2%
Box Elder Co (Other)65.6%50.8%77.8%
Logan76.7%67.9%83.7%
Cache Co (Oth)/Rich Co (All)66.1%56.7%74.4%
Ben Lomond72.9%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 Ogden66.9%54.2%77.6%
Roy/Hooper70.0%58.6%79.4%
Riverdale82.3%71.5%89.6%
Clearfield/Hill AFB66.3%56.6%74.8%
Layton69.8%59.2%78.6%
Syracuse/Kaysville78.1%69.4%84.8%
Farmington/Centerville71.5%60.5%80.4%
Woods Cross/North Salt Lake61.5%47.8%73.6%
Bountiful74.5%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%
Magna65.4%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) V265.9%51.2%78.0%##
SLC (Downtown)52.4%40.5%64.1%
South Salt Lake56.9%41.1%71.3%
Millcreek74.6%65.3%82.1%
Holladay81.5%71.5%88.5%
Cottonwood71.6%61.7%79.8%
Kearns55.7%35.4%74.2%#
Kearns V252.6%39.4%65.4%##
Taylorsville (E)/Murray (W)75.9%64.8%84.3%
Taylorsville (West)66.2%50.8%78.8%##
Murray74.1%62.9%82.8%
Midvale67.1%55.6%76.8%
West Jordan (NE)57.2%33.8%77.8%#
West Jordan (NE) V265.7%51.1%77.8%##
West Jordan (SE)70.7%59.0%80.2%
West Jordan (W)/Copperton76.0%64.0%85.0%
South Jordan73.5%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/Draper64.8%57.8%71.3%
Tooele Co63.9%57.3%70.0%
Lehi/Cedar Valley48.0%36.9%59.4%
American Fork/Alpine65.0%53.9%74.8%
Pleasant Grove/Lindon67.6%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)/BYU68.9%53.0%81.3%
Provo (South)69.8%53.1%83.4%
Springville/Spanish Fork68.3%59.6%75.9%
Utah Co (South)65.0%53.4%75.2%
Summit Co76.5%69.9%82.1%
Wasatch Co70.7%63.2%77.2%
TriCounty LHD55.3%47.4%62.8%
Juab/Millard/Sanpete Co53.6%45.4%61.0%
Sevier/Piute/Wayne Co76.6%67.8%83.7%
Carbon/Emery Co65.6%57.3%73.0%
Grand/San Juan Co40.5%30.3%51.6%
St George66.5%53.4%77.5%
Washington Co (Other)69.2%60.2%77.0%
Cedar City65.0%51.1%76.7%
Southwest LHD (Other)71.1%58.3%81.2%
State66.9%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 Source

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 EthnicityAge-adjusted Percentage of Women Age 40+Lower LimitUpper Limit
Record Count: 3
Hispanic61.8%55.4%67.8%
Non-Hispanic67.2%65.8%68.6%
All Utahns66.9%65.5%68.3%

Data Notes

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

Data Source

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

::chart - missing::
confidence limits

RaceAge-adjusted Percentage of Women Age 40+Lower LimitUpper LimitNote
Record Count: 6
American Indian/Native Alaskan54.8%39.8%68.9%
Asian82.2%72.0%89.2%
Black75.2%60.3%85.8%
Pacific Islander46.9%21.1%74.5%*
White66.8%65.3%68.2%
All Races66.9%65.5%68.3%

Data Notes

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

Data Source

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

::chart - missing::
confidence limits

Education LevelAge-adjusted Percentage of Women Age 40+Lower LimitUpper Limit
Record Count: 5
Less Than High School56.2%49.4%62.8%
H.S. Grad or G.E.D.66.3%63.4%69.0%
Some Post High School66.5%64.2%68.7%
College Graduate71.7%69.4%73.8%
Total66.9%65.5%68.3%

Data Notes

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

Data Source

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

::chart - missing::
confidence limits

Income CategoryAge-adjusted Percentage of Women Age 40+Lower LimitUpper Limit
Record Count: 5
<$25,00056.4%52.7%60.0%
$25,000-$49,99963.0%59.7%66.2%
$50,000-$74,99970.0%66.6%73.3%
$75,000+74.7%71.6%77.6%
Total66.9%65.5%68.3%

Data Notes

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

Data Source

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

::chart - missing::
confidence limits

Age GroupPercentage of WomenLower LimitUpper Limit
Record Count: 3
Age 40-4959.3%56.4%62.1%
Age 50-6472.6%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 Department of Health's Center for Health Data IBIS-PH web site (http://ibis.health.state.gov). The information published on this website may be reproduced without permission. Please use the following citation: " Retrieved Fri, 04 September 2015 21:41:44 from Department of Health, Center for Health Data, Indicator-Based Information System for Public Health Web site: http://ibis.health.state.gov ".

Content updated: Tue, 28 Jul 2015 19:46:08 MDT