(ChemotherapyAdvisor) – Out-of-pocket expenses, convenience of screening, fear of diagnosis, and the mammography test itself were modifiable barriers to screening identified among a survey of predominantly rural U.S. women, results of which were reported during the 2013 Breast Cancer Symposium held in San Francisco, CA.

To evaluate the prevalence of annual and biennial mammography screening and identify potential disparities and barriers to breast cancer screening, Jeffrey Peppercorn, MD, MPH, Assistant Professor of Medicine, Division of Medical Oncology, Duke University Medical Center, Durham, NC, and colleagues conducted a national cross-sectional survey of women insured by the National Rural Electric Cooperative Association.

A study-specific survey was mailed to 2,000 randomly selected eligible women between the ages of 40 and 65 years without a prior diagnosis of breast cancer.

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For all women, demographics and receipt of mammography within the previous 12 months were assessed and, for women 44 years and older, the number of screening mammograms within the previous 4 years.

A total of 1,204 women responded to the survey, for a response rate of 60.2%. Of the women, 74% lived in rural areas; 18%, suburban; and 8%, urban. Nearly three quarters (73%) reported less than 4 years of college education and 19% had family incomes of less than $50,000 annually.

Overall, 72% reported having screening mammography within the previous 12 months; 59%, consistent annual screening, and 84%, at least biennial screening, Dr. Peppercorn reported.

Compared with women in non-rural areas, rural women were less likely to undergo consistent annual (56% vs. 66%; P=0.003) or biennial screening (82% vs. 89%, P=0.01). Women younger than 50 years were less likely to report screening within the previous 12 months (67% vs. 77%; P=0.0002) and 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,” Dr. Peppercorn said.

Fear of the test was observed to be a greater barrier among younger compared with older women (P<0.02). In univariate analysis, they found that household income did not correlate with screening, and education was only a factor among younger women.