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What's New - Mammogram Study

Kaiser Permanente Northwest one of seven sites in national breast cancer study

New Study Backs Importance of Regular Mammograms

(PORTLAND, Ore.) - October 18, 2004 - More than half of women with late-stage breast cancer had not had a mammogram between one and three years before diagnosis according to a new study in the Oct. 20 issue of the Journal of the National Cancer Institute. The study also found that older, unmarried, less educated, and lower income women were less likely to get a mammogram than other women.

The study was conducted by researchers at Kaiser Permanente Northwest and six other health plans involved in the Cancer Research Network ? a nationwide consortium of health care organizations. The Network studies the effectiveness of interventions to treat and prevent cancer. The study was funded by a grant from the National Cancer Institute. The study used data on 1.5 million women aged 50 and older who were members of the seven health plans in Oregon, Washington State, California, Hawaii, Colorado and Michigan. They compared 1,347 women diagnosed with late-stage breast cancer between 1995 and 1999 with an equal number of women diagnosed with early-stage breast cancer. On the basis of their care between one and three years prior to diagnosis, the researchers divided the women into three groups: 1) absence of screening (no screening mammogram was done); 2) absence of detection (earliest screening mammogram was negative); and 3) potential breakdown in follow-up (mammogram was positive but diagnosis occurred more than a year later).

The researchers found that just over half (52 percent) of the late-stage breast cancer cases were in women who had not had a screening mammogram one to three years prior to diagnosis. About two-fifths (39 percent) were in women who had gotten a mammogram but cancer had not been detected. A final 8 percent were in women whose diagnosis came a year or more after getting a mammogram that showed signs of breast cancer.

The odds of having late-stage breast cancer were nearly doubled among women who didn't have mammograms. Among all women diagnosed with late-stage breast cancer, women were less likely to have had a mammogram during the study period if they were 75 or older, unmarried, or didn't have a family history of breast cancer. Women who had less education or lower income were also less likely to have gotten regular mammograms.

"These results emphasize how important it is for women to get mammograms," says Sheila Weinmann, PhD, one of the study's co-authors and a senior research associate at Kaiser Permanente's Center for Health Research in Portland. "Women need to be screened regularly and within the appropriate time frame ? every two years for women 50 and older ? so physicians can catch changes in breast tissue early and be able to identify and treat cancers at an early stage. These results also emphasize that health plans need to figure out more effective ways to convince women who aren't currently getting mammograms of the importance of doing so."

At Kaiser Permanente Northwest, 75 percent of all women 50 and older do get mammograms within a recommended two-year interval, according to the National Committee on Quality Assurance.

Weinmann says of women who had a breast cancer detected during the five years the study looked at, 86 percent had their cancers detected at an early stage. Compared to national data, this is a very good record for detecting breast cancer early, she says. Fourteen percent of the cancers were detected at a late stage, prompting Weinmann to say, "We all need to do better. All women 50 and older need to heed notices when they are due or overdue for a mammogram. And health plans and physicians need to do a better job of convincing women who aren't getting mammograms that regular screenings are crucial for their health."

The current study supports earlier research done at CHR which showed that embarrassment, mistrust of the medical system, and pessimism about whether cancer screening and treatment did any good were key factors keeping some women from getting a mammogram. Beliefs that "nothing can be done if a problem is found" and misconceptions that mammograms aren't important for elderly women or for women with no family history of breast cancer, also seem to play a role in some women not coming in for recommended screening. For example, statistics from Kaiser Permanente show that women in their 60s and 70s are less likely to have had a mammogram in the previous year than women in their 50s (75 percent of the 60 year olds and 70 year olds received a mammogram versus 85 percent of women in their 50s).

Other health plans involved in this study are:

• Group Health Cooperative (Seattle)
• Henry Ford Health System (Detroit, Mich.)
• Kaiser Permanente plans in Colorado, Hawaii, Northern California and Southern California.

Kaiser Permanente's Center for Health Research, founded in 1964, is a non-profit research institution whose mission is advancing knowledge to improve health.

Kaiser Permanente is a group practice health care organization founded in 1945 and serving the health needs of 450,000 people in Oregon and Southwest Washington.

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Released: October 19, 2004