Disparities in adherence to recommended followup on screening mammography: Interaction of sociodemographic factors

Objective: The objective of this study was to examine disparities in adherence to screening mammography and, specifically, to investigate whether race/ethnicity, education, age, health insurance, and family history of breast cancer (FHBC), as unique factors and in interactions, influence adherence to recommended follow up on screening mammography. Design: The study involved retrieval and analyses of data collected by the Colorado Mammography Project (CMAP) for 167,232 diverse (82.8% White, 3.4% Black, 11% Hispanic, 1.6% Asian, 0.6% Native American, and 0.6% "other") screening participants during the 1990-1997 study period. Methods: Subjects' first mammograms captured by CMAP were tracked in the data-base to identify women who received follow-up recommendations, women who adhered within 12 months and those that did not. Analyses included comparisons of adherence rates among women with various sociodemographic characteristics. Results: Of the 17,358 women who received follow-up recommendations, 80.7% adhered. Overall, non-White women in each of the racial/ethnic groups were less likely to adhere to recommendations than were White women (P<.05). Also less likely to adhere were the younger, less educated, uninsured/underinsured, and women who reported not having FHBC. Conclusion: Race/ethnicity appeared to interact with age, education, health insurance, and FHBC to influence the probability of adherence, suggesting the need to explore further cultural, psychosocial, and situational factors.