13 Background: Screening mammography leads to early detection of breast cancer and improved survival. We conducted a survey of predominantly rural U.S. women who receive health insurance through the National Rural Electric Cooperative Association (NRECA) to evaluate the prevalence of annual and biennial screening and to identify potential disparities and barriers to breast cancer screening. Methods: We conducted a national cross-sectional survey of women between ages 40 and 65 who are insured by the NRECA regarding their utilization of mammography screening and barriers to screening. A study specific survey was mailed to 2,000 randomly selected eligible women without prior diagnosis of breast cancer. We assessed demographics and receipt of mammography within past 12 months (all women) and number of screening mammograms within the past 4 years (among women age 44 and older) to identify consistent annual screening and biennial screening patterns. Results: 1,204 women responded to the survey (response rate 60.2%). 74% live in rural areas, 18% suburban, 8% urban. 73% report less than 4 years college education and 19% have family incomes < $50,000/year. Overall, 72% reported screening mammography within 12 months, 59% reported consistent annual screening and 84% reported at least biennial screening. Rural women were less likely to undergo consistent annual (56% vs. 66%, p = 0.003) or biennial screening (82% vs. 89%, p = 0.01) compared to women in non-rural areas. Women under 50 were less likely to report screening within 12 months (67% vs. 77%, p = 0.0002), consistent annual (49% vs. 63%, p < 0.0001) or biennial screening (79% vs. 86%, p = 0.002). Significantly more rural women cited cost and distance as barriers, while busy schedule, fear of diagnosis, and fear of discomfort were important barriers among all demographic groups. Fear of the test was a greater barrier among younger vs. older women (p < 0.02). In univariate analysis; household income did not correlate with screening, and education was only a factor among younger women. Conclusions: A substantial percentage of rural U.S. women fail to undergo screening mammography. Potentially modifiable barriers include out of pocket expenses, convenience of screening, and fear of diagnosis and the test itself.
Reply to Opportunity cost of annual screening mammography
