Table 3. Variables retained in the final model were those significant at a P value less than or equal to .01 level. We calculated odds ratios and 95% confidence intervals for independent variables in the model.
Results
Demographic and Medical History Factors
Seventy-four percent of the participants had more than a high school education. Eighty-two percent were white Table 2. The majority were married (78%), worked for pay (89%), and reported adequate income (91%).
One fourth reported a previous abnormal mammogram; 13% reported at least 1 biopsy; and 9% reported a first-degree relative with breast cancer.
Off-schedule women were less likely than those who were on schedule to report first-degree relatives with breast cancer, previous abnormal mammograms, and breast biopsies.
Provider-Related Information and Knowledge About Screening
The majority of women reported having a regular physician who recommended a mammogram within the past 2 years Table 2. Although most reported that they shared in medical testing decisions with their physicians, only 12% reported having raised questions about breast cancer screening with their physicians during the past 2 years. Off-schedule women were less likely than those on schedule to report having a regular physician and receiving a mammography recommendation in the past 2 years. Off-schedule women were more likely to report these factors than those never screened.
Almost all women reported that they believed mammograms to be effective in reducing breast cancer deaths, but women who were on and off schedule were more likely to do so than the never-had group. Off-schedule women were less likely than the on-schedule and never-had groups to correctly report screening recommendations for women their age.
Risk Perceptions
Comparative risk perceptions were associated with mammography history Table 2. Women who never had a mammogram perceived their comparative risk as lower than those in the on- and off-schedule groups, with off-schedule women falling between the never-had and on-schedule groups.
Perceptions About Mammography
The 3 groups of women differed significantly in perceptions about mammography Table 2. Off-schedule women were more likely than on-schedule women, but less likely than the never-had group, to be ambivalent about mammography and confused about guidelines. Off-schedule women were less likely than on-schedule women to report insufficient information to decide to get a mammogram, but were also more likely than the never-had group to report enough information.
Pro and con mammography scores, which reflected women’s positive and negative beliefs about mammography screening and the likelihood of being screened, were associated with their mammography history (data not shown). The off-schedule group had a significantly lower mean pro score (mean=9.4, standard deviation [SD] =2.4) than on-schedule women (mean=10, SD=1.5), but had a significantly higher mean pro score than the never-had group (mean=7.7, SD=3.6, P <.001). The off-schedule group had a significantly higher mean con score (mean=-5.5, SD=3.1) than on-schedule women (mean=-6.3, SD=2.7), but had a significantly lower mean con score than the never-had group (mean=-3.7, SD=3.6, P <.001).
Screening and Other Health-Related Behaviors
Overall, the majority of the women reported recent CBEs and Papanicolaou (Pap) tests. Approximately half said they got regular exercise and had used HRT Table 3.
Recent CBE and Pap tests were associated with mammography history. Off-schedule women were less likely than those who were on schedule but more likely than the never-had group to report both having a CBE within the past 12 months and a Pap test within 24 months. This pattern persisted among younger (42 to 45 years) and older (50 to 55 years) women.
Previous and current HRT use were associated with mammography history for women aged 50 years and older. Off-schedule women were less likely than on-schedule women, but more likely than women who never had a mammogram, to have used HRT.
Cigarette smoking was associated with mammography history. Women who never had mammograms were more likely to be current smokers than those in the on- and off-schedule groups.
We tested whether women off schedule for mammography were also off schedule for CBEs and cervical screening Table 4. Women who had a CBE within the past 12 months and a Pap test within the past 24 months were considered on schedule for both tests. A chi-square test of trend (P <.001) revealed a strong relationship between being on schedule for mammography screening and being on schedule for CBE and cervical screening.
Multivariate Analysis
Important factors associated with being off schedule for screening mammography were: being aged 50 to 54 years, not having a CBE within the past 12 months, being ambivalent about mammography, low perception of breast cancer risk, not being advised to have a mammogram by a physician in the past 2 years, confusion about screening mammography, and never having an abnormal mammogram Table 5.