PHOM Indicator Profile Report of Breast Cancer Screening (Mammography)

Why Is This Important?

Breast cancer is the most commonly occurring cancer in U.S. women (excluding skin cancers) and the leading cause of female cancer death in Utah. Deaths from breast cancer can be substantially reduced if the tumor is discovered at an early stage. Mammography is currently the best method for detecting cancer early. A mammogram is a noninvasive x-ray used to look for early signs of breast cancer. Clinical trials and observational studies have demonstrated that routine screening with mammography can reduce breast cancer mortality by roughly 20% for women of average risk.^1^ The American College of Radiology (ACR) and Society of Breast Imaging (SBI) recommend getting annual mammograms starting at age 40 for women of average risk, but earlier and more intensive screening for high-risk patients.^2^ Significant scientific evidence has demonstrated that this approach saves more lives than delayed or less frequent screening.^3^[[br]] [[br]] ---- 1. Myers ER, Moorman P, Gierisch JM, et al. Benefits and harms of breast cancer screening. JAMA. doi:10.1001/jama.2015.13183.[[br]] 2. D.L. Monticciolo et al. Breast cancer screening in women at higher-than-average risk: recommendations from the ACR. J Am Coll Radiol, 20 (9) (2023), pp. 902-914.[[br]] 3. American College of Radiology Committee on BI-RADS. Mammography Saves Lives. Available at: [https://www.acr.org/Practice-Management-Quality-Informatics/Practice-Toolkit/Patient-Resources/Mammography-Saves-Lives]. Accessed on January 1, 2023.

Data Notes

Age-adjusted to U.S. 2000 standard population. Data provided for all years available. Old Methodology: Previous BRFSS methodology used "post-stratification" which was used to weight data by age, gender, and local health district (LHD). New Methodology: To reduce bias and more accurately represent population data, the BRFSS has changed survey methodology. It began conducting surveys by cellular phone in addition to landline phones. It also adopted "iterative proportional fitting" (raking) as its weighting method. With raking, education, race/ethnicity, marital status, home ownership/renter, and telephone source are included in the weighting procedure. Due to changes in sampling and weighting methodology, data from the new methodology represents a new baseline, and comparisons from new to old methodology data are not appropriate.

Risk Factors

The most important risk factor for breast cancer is increasing age. Other established risk factors include personal or family history of breast cancer, history of abnormal breast biopsy, genetic alterations, early age at onset of menses, late age at onset of menopause, never having children or having a first live birth at age 30 or older, and history of exposure to high dose radiation. Associations have also been suggested between breast cancer and oral contraceptives, long-term use of hormone replacement therapy, obesity (in post-menopausal women), alcohol, and a diet high in fat. Some studies suggest that exercise in youth might give life-long protection against breast cancer and that even moderate physical activity as an adult could lower breast cancer risk. More research is needed to confirm these findings.

How Are We Doing?

Between 1989 and 2022, the percentage of Utah women aged 40 or older who reported receiving a mammogram within the last two years increased from 51.6% to 63.8%. Although rates have increased some over time, the rate in Utah still falls far below the national average. In 2022, the mammography screening rate in Utah was significantly lower than the U.S. rate of 68.2%. Utah is ranked 44th in the nation for mammography screening. In 2022, the percentage of women who received a mammogram in TriCounty Local Health District (52.7%) was statistically significantly lower than the state average (63.8%). Conversely, the screening rate in Summit County Local Health District (78.4%) was significantly higher than the overall rate in Utah. See additional data views for more specific geographic differences between the Utah Small Areas. For the same year, there were no significant differences in mammography screening rates between Hispanic and non-Hispanic ethnic groups, nor were there any significant differences in rates among different racial groups for combined data years 2018, 2019, 2020, and 2022. Mammography rates generally tend to increase with age, education level, and amount of household income increases. In 2020 and 2022 combined, women age 40-49 had significantly lower rates of mammography screening (52.4%) than older women (69.3%; most likely due to differing guidelines concerning the age at which breast cancer screening should begin). Looking at the level of education completed for the same time period, college graduates were significantly more likely to have received a mammogram (67.8%) than the general population (63.3%), whereas the screening rate among women who had not completed high school was significantly lower than the state average at just 53.4%. In the same timeframe, women in households with an annual income of less than $25,000 were significantly less likely to have had a mammogram in the past two years (50.9%) compared to other women, whereas women in households with an annual income of more than $75,000 were more likely to have had a mammogram in the past two years (68.4%).

What Is Being Done?

The Utah Breast & Cervical Cancer Program (Utah B&C) partners with local health departments, community clinics, hospitals, and healthcare professionals to help those with low incomes who do not have adequate insurance gain access to timely breast and cervical cancer screening, diagnostic and treatment services. Eligible women can apply to Utah B&C by calling 800-717-1811 or by submitting an online enrollment form available at: [https://cancerutah.org/do-i-qualify/]. The Utah Cancer Coalition is a statewide partnership whose goal is to reduce the burden of cancer. The mission of the coalition is to lower cancer incidence and mortality in Utah through collaborative efforts directed toward cancer prevention and control. As a result of this planning process, objectives and strategies have been developed by community partners regarding the early detection of cervical, testicular, prostate, skin, breast, and colorectal cancers as well as the promotion of physical activity, healthy eating habits, and smoking cessation.