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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 and observational studies have demonstrated that routine screening with mammography can reduce breast cancer mortality by about 20% for women of average risk.^1^ The U.S. Preventive Services Task Force recommends that women 50-74 years of age undergo mammography every two years, while the American Cancer Society recommends that women aged 40-44 should have the choice to start annual screenings, women 45-54 years old should have annual mammograms, and women 55 and older should have mammograms every other year as long as they are healthy and likely to live for 10 or more years. 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. ''1. Myers ER, Moorman P, Gierisch JM, et al. Benefits and harms of breast cancer screening. JAMA. doi:10.1001/jama.2015.13183.''

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: currently being revised

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 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 2014 rate was 64.5 percent (age-adjusted rate). All additional indicator views are based on the new methodology. For combined years 2012 to 2014, there were no significant differences in mammography screening rates between Hispanic and non-Hispanic ethnic groups. Among different races, American Indians had the lowest screening rates and Asians had the highest screening rates; however, there were no significant differences among races. Summit County Local Health District reported significantly higher screening rates than the state (75.7 percent), while three local health districts reported significantly lower screening rates when compared to the state (Central, 56.2 percent; Southeast, 53.2 percent; and TriCounty, 52.5 percent) for combined years 2013-2014. After dividing the health districts into Utah Small Areas the prevalence of mammograms, for combined years 2012-2014, ranged from a high of 78.4 percent in Riverdale to a low of 39.1 percent in Grand/San Juan. In 2014, 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 (52.7 percent vs 71.7 percent among women 50-64 and 71.4 percent among women 65 and over). In 2014, when looking at the highest level of education completed, college graduates were significantly more likely to have received a mammogram than persons with a high school degree or less (college graduate, 69.4 percent; high school graduate, 63.4 percent; below high school, 54.6 percent). Also in 2014, women in households with an annual income of less than $25,000 were significantly less likely to have had a mammogram in the past two years compared to those in households earning $50,000 or more (52.3 percent vs. 66.7 percent for incomes of $50,000-$75,000 and 71.5 percent for incomes of $75,000 or more).

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, 64.5 percent of Utah women aged 40 and older had received a mammogram in the last two years compared with 72.3 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. 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. Although the Affordable Care Act (ACA) mandates coverage of screening mammograms, many women are still uninsured or need financial assistance for diagnostic mammograms and other services.


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. Older women, women with less education, and women living in poverty are groups which are less likely to get a mammogram.

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., 1989-2014

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confidence limits

BRFSS Utah vs. U.S.YearAge-adjusted Percentage of Women Age 40+Lower LimitUpper Limit
Record Count: 41
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 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%
UT New Methodology201464.5%62.8%66.1%
US New Methodology201273.1%72.7%73.6%
US New Methodology201472.3%71.9%72.8%

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. Due to changes in sampling and weighting methodology, data from the new methodology represents a new baseline, and comparisons from new to old methodology data are not appropriate.

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, 2013-2014

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confidence limits

Local Health DistrictAge-adjusted Percentage of Women Age 40+Lower LimitUpper Limit
Record Count: 13
Bear River69.5%63.2%75.1%
Central56.2%48.8%63.3%
Davis County66.3%61.7%70.7%
Salt Lake County64.7%62.0%67.3%
Southeast53.2%45.4%60.8%
Southwest70.2%64.1%75.7%
Summit75.7%68.6%81.6%
Tooele66.8%58.5%74.2%
TriCounty52.5%43.5%61.4%
Utah County65.4%61.3%69.4%
Wasatch72.3%65.3%78.4%
Weber-Morgan68.4%62.9%73.3%
State65.1%63.6%66.7%

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, 2012-2014

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confidence limits

Utah Small AreasAge-adjusted Percentage of Women Age 40+Lower LimitUpper Limit
Record Count: 64
Brigham City64.3%52.8%74.3%
Box Elder Co (Other)64.1%51.7%74.9%
Logan69.8%61.4%77.1%
Cache Co (Oth)/Rich Co (All)70.8%62.2%78.2%
Ben Lomond71.3%62.7%78.6%
Morgan Co (All)/Weber Co (E)75.2%67.8%81.4%
Ogden (Downtown)64.2%53.3%73.8%
South Ogden71.4%60.3%80.5%
Roy/Hooper71.0%61.6%78.9%
Riverdale78.4%68.7%85.7%
Clearfield/Hill AFB61.6%53.1%69.4%
Layton69.8%62.3%76.4%
Syracuse/Kaysville72.7%65.0%79.3%
Farmington/Centerville70.6%60.4%79.1%
Woods Cross/North Salt Lake71.5%61.0%80.0%
Bountiful67.4%58.7%75.0%
SLC (Rose Park)56.6%45.1%67.5%
SLC (Avenues)61.8%48.8%73.2%
SLC (Foothill/U of U)62.0%52.7%70.4%
Magna62.4%49.5%73.7%
SLC (Glendale)48.4%35.8%61.2%
West Valley (West)60.5%52.1%68.3%
West Valley (East) V264.6%53.5%74.3%
SLC (Downtown)55.2%44.7%65.3%
South Salt Lake57.0%43.7%69.4%
Millcreek72.2%64.0%79.1%
Holladay74.6%65.0%82.3%
Cottonwood66.7%58.0%74.4%
Kearns V255.4%44.6%65.7%
Taylorsville (E)/Murray (W)64.6%52.5%75.1%
Taylorsville (West)65.2%53.2%75.5%
Murray73.3%63.0%81.5%
Midvale71.2%59.4%80.7%
West Jordan (NE) V258.8%47.0%69.7%
West Jordan (SE)70.5%60.2%79.0%
West Jordan (W)/Copperton74.5%64.3%82.7%
South Jordan73.4%65.3%80.1%
Sandy (Center)67.1%58.8%74.4%
Sandy (NE)68.9%57.9%78.1%
Sandy (SE)74.3%64.1%82.5%
Riverton/Draper65.0%59.3%70.2%
Tooele Co65.4%59.1%71.3%
Lehi/Cedar Valley47.9%38.5%57.6%
American Fork/Alpine69.8%60.6%77.8%
Pleasant Grove/Lindon68.6%59.8%76.3%
Orem (North)62.4%50.4%73.2%
Orem (West)73.0%59.7%83.2%
Orem (East)75.2%64.7%83.4%
Provo (North)/BYU67.2%55.1%77.4%
Provo (South)69.7%57.7%79.5%
Springville/Spanish Fork67.7%60.4%74.3%
Utah Co (South)61.2%50.0%71.3%
Summit Co72.8%66.6%78.2%
Wasatch Co68.4%62.3%73.9%
TriCounty LHD53.8%46.6%60.9%
Juab/Millard/Sanpete Co53.6%47.0%60.0%
Sevier/Piute/Wayne Co73.3%64.8%80.4%
Carbon/Emery Co62.6%54.5%70.0%
Grand/San Juan Co39.1%31.2%47.7%
St George67.5%58.2%75.6%
Washington Co (Other)70.1%62.5%76.7%
Cedar City61.8%49.8%72.5%
Southwest LHD (Other)66.7%56.2%75.8%
State66.1%64.9%67.2%

Data Notes

Age-adjusted to U.S. 2000 standard population. Maps, methods, and changes to Utah Small Areas may be found on IBIS at the following URL: [http://ibis.health.utah.gov/resource/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, 2012-2014

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confidence limits

Hispanic EthnicityAge-adjusted Percentage of Women Age 40+Lower LimitUpper Limit
Record Count: 3
Hispanic63.0%57.9%67.9%
Non-Hispanic66.3%65.1%67.5%
All Utahns66.1%64.9%67.2%

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, 2012-2014

::chart - missing::
confidence limits

RaceAge-adjusted Percentage of Women Age 40+Lower LimitUpper Limit
Record Count: 6
American Indian/Native Alaskan53.7%41.4%65.5%
Asian74.3%63.3%82.9%
Black70.4%56.5%81.2%
Pacific Islander69.2%49.0%84.0%
White66.4%65.2%67.6%
All Races66.1%64.9%67.2%

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 Education, Utah, 2014

::chart - missing::
confidence limits

Education LevelAge-adjusted Percentage of Women Age 40+Lower LimitUpper Limit
Record Count: 5
Less Than High School54.6%47.4%61.5%
H.S. Grad or G.E.D.63.4%60.1%66.6%
Some Post High School64.2%61.3%66.9%
College Graduate69.4%66.8%72.0%
Total64.5%62.8%66.1%

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, 2014

::chart - missing::
confidence limits

Income CategoryAge-adjusted Percentage of Women Age 40+Lower LimitUpper Limit
Record Count: 5
<$25,00052.3%47.9%56.6%
$25,000-$49,99960.3%56.3%64.2%
$50,000-$74,99966.7%62.6%70.5%
$75,000+71.5%67.7%75.1%
Total64.5%62.8%66.1%

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, 2014

::chart - missing::
confidence limits

Age GroupPercentage of WomenLower LimitUpper Limit
Record Count: 3
Age 40-4952.7%49.2%56.0%
Age 50-6471.7%69.2%74.0%
Age 65+71.4%68.8%73.9%

Data Source

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

References and Community Resources

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

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 11/05/2015, Published on 11/25/2015
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 Thu, 28 April 2016 19:54:06 from Department of Health, Center for Health Data, Indicator-Based Information System for Public Health Web site: http://ibis.health.state.gov ".

Content updated: Wed, 25 Nov 2015 14:23:43 MST