Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA.
Department of Radiology, University of Wisconsin-Madison, Madison, WI.
Acad Radiol. 2023 Jun;30(6):1101-1106. doi: 10.1016/j.acra.2022.07.014. Epub 2022 Aug 12.
While the American College of Radiology recommends annual screening mammography starting at age 40 years, the US Preventive Services Task Force (USPSTF) recommends that screening mammography in women younger than age 50 years should involve shared- decision making (SDM) between clinicians and patients, considering benefits and potential harms in younger women. Using a nationally representative cross-sectional survey, we aimed to evaluate patient-reported reasons and predictors of screening mammography utilization in this age group.
Respondents aged 40-49 years from the 2018 National Health Interview Survey (NHIS) without a history of breast cancer were included (response rate 64%). Participants reported sociodemographic variables and reasons they did not engage in mammography screening within the last two years. Multiple variable logistic regression analyses were performed to evaluate the association between sociodemographic characteristics and patient-reported screening mammography use, accounting for complex survey sampling design elements.
1,948 women between the ages of 40-49 years were included. Of this group, (758/1948) 46.6% reported receiving a screening mammogram within the last year, and 1196/1948 (61.4%) reported receiving a screening mammogram within the last two years. The most common reasons for not undergoing screening included: "No reason/never thought about it" 744/1948 (38.2%), "Put it off" 343/1948 (17.6%), "Didn't need it" 331/1948 (16.9%), "Doctor didn't order it" 162/1948 (8.3%), and "I'm too young" 63/1948 (5.3%). Multiple variable analyses demonstrated that lack of health insurance was the strongest predictor of mammography non-engagement (p< 0.001).
Deficits in shared- decision-making in women younger than 50 years related to mammography utilization exist. Radiologists may be key in addressing this issue among ambulatory care providers and patients, educating about the benefits and harms of screening younger women, particularly in racial/ethnic minorities and uninsured patients, who experience additional barriers to care and SDM discussions.
虽然美国放射学院建议从 40 岁开始每年进行筛查性乳房 X 光检查，但美国预防服务工作组（USPSTF）建议，年龄在 50 岁以下的女性进行筛查性乳房 X 光检查应涉及临床医生和患者之间的共同决策（SDM），考虑到年轻女性的获益和潜在危害。本研究使用全国代表性的横断面调查，旨在评估该年龄段患者报告的筛查性乳房 X 光检查利用的原因和预测因素。
纳入了来自 2018 年全国健康访谈调查（NHIS）、无乳腺癌病史且年龄在 40-49 岁的应答者（应答率为 64%）。参与者报告了社会人口统计学变量以及他们在过去两年内未进行乳房 X 光筛查的原因。采用多变量逻辑回归分析评估社会人口统计学特征与患者报告的筛查性乳房 X 光检查使用之间的关联，同时考虑了复杂的调查抽样设计元素。
共纳入 1948 名 40-49 岁的女性。其中，（758/1948）74.6%的人报告在过去一年接受了筛查性乳房 X 光检查，1196/1948（61.4%）的人报告在过去两年接受了筛查性乳房 X 光检查。未进行筛查的最常见原因包括：“无原因/从未考虑过”744/1948（38.2%）、“推迟”343/1948（17.6%）、“不需要”331/1948（16.9%）、“医生未开单”162/1948（8.3%）和“太年轻”63/1948（5.3%）。多变量分析表明，缺乏健康保险是导致乳房 X 光检查不参与的最强预测因素（p<0.001）。
在与 50 岁以下女性的乳房 X 光检查利用相关的决策中存在共同决策的不足。放射科医生可能是解决这一问题的关键，他们可以在门诊医疗服务提供者和患者中开展教育，告知筛查年轻女性的获益和危害，特别是在种族/民族少数群体和没有保险的患者中，这些患者在获得医疗保健和 SDM 讨论方面面临额外的障碍。
