摘要：Mammography screening rates in the United States have remained fairly stable over the past decade, and screening rates remain low for some groups. We examined insights from recent public health research on breast cancer screening to identify promising new approaches to improve screening rates and address persistent health disparities in mammography use. We considered this research in the context of the four strategic directions of the National Prevention Strategy: elimination of health disparities, empowered people, healthy and safe community environments, and clinical and community preventive services. This research points to the value of direct outreach and case management services, interventions to support more patient-centered models of care, and more organized, population-based approaches to identify women who are eligible to be screened, encourage participation, and monitor results. OVERALL, ABOUT ONE IN FOUR women in the United States aged 50 to 74 years have not had a mammogram within the past two years, as is recommended. 1 Mammography use is substantially lower for certain subgroups, such as low-income women, women without health insurance, and women without a usual source of care. 1–3 In addition, breast cancer screening rates have not improved in almost a decade 1,4,5 and the Healthy People 2010 target that 70% of women aged 40 to 74 years received a mammogram in the past two years was not achieved. 6 The Healthy People 2020 cancer objective uses new age guidelines and calls for a 10% improvement in the proportion of women aged 50 to 74 years who received a mammogram in the previous two years, as well as a reduction in late-stage female breast cancer (an intermediate outcome of cancer screening success). 7 Current efforts and approaches are clearly not sufficient to meet these national goals. New approaches are needed to further increase mammography utilization to achieve Healthy People 2020 objectives. Whether a woman receives a mammogram is influenced by a range of personal, social, and economic factors, and these factors are interrelated. The use of scientific evidence from extensive research on the determinants of mammography utilization could increase effective public health practice. The National Prevention Strategy 8 outlined four strategic directions to integrate recommendations across multiple settings: elimination of health disparities, empowered people, healthy and safe community environments, and clinical and community preventive services. The purpose of this analysis was to examine insights gained from recent research on breast cancer screening in the context of these four strategic directions for prevention. Integrating efforts in a coordinated public health effort may result in improved mammography utilization, reduction in breast cancer mortality, and improvement in longstanding health disparities.
