Date of Award


Degree Type


Degree Name

Master of Science (MS)


Pharmaceutical Sciences

First Advisor

Brian J. Quilliam


Statement of the Problem: The disease burden of breast cancer remains strong as the second leading cause of cancer death among women in the United States.1 Despite this, the rate of women receiving a mammogram has shown little improvement since 2000.2 As health insurance will provide expanded coverage for mammography through the Affordable Care Act, it is essential to identify and describe women who have a lower probability of receiving the recommended breast cancer screening.

Objective: To describe trends in receipt of biennial mammography in women in the United States, and to further identify independent sociodemographic and clinical predictors of women not receiving a mammography as recommended by national guidelines.

Methods: Using data from the 2008-2010 Medical Expenditure Panel Survey (MEPS), I conducted a cross-sectional study and selected women forty years of age or older who had identified the time since their last mammogram as asked in the Preventive Care supplement. Within the final sample of 20,796 women, I assessed trends in mammography use in the previous two years, and differences in sociodemographic, clinical and type of usual source of care (creating 2 groups: no mammography, yes mammography). For analytic purposes, this study was analyzed as a case control study comparing women without a mammogram to women who had received a mammogram in the past 2 years. An unconditional logistic regression model was used to identify predictors of missed mammography and the data were weighted using SUDAAN software to account for the complex survey design and the nationally representative sampling scheme.

Results: Overall, in the weighted sample of 210,485,707 women, 26.9% (n=56,532,799) did not receive a mammogram in the previous 2 years. Women in the case group (absence of recommended mammography) were of similar age and race/ethnicity as women in the control group (presence of recommended mammography). Overall, the study population consisted mostly of women aged 40-59 comprised by 60.1% of the cases and 57.9% of the controls. In multivariable modeling, the strongest predictor of missing a recommended mammogram was not having a usual source of care (OR=2.86; 95% CI, 2.52-3.25) and women without insurance during the study period (OR=2.34; 95% CI, 2.07-2.65).

Conclusions: More than 1 in 4 women, or approximately 57 million women, did not receive the recommended biennial mammogram screening. Women without a usual source of care were less likely to receive the recommended screening, but variation across type of usual source of care was not apparent in my study. Age, race/ethnicity and other demographic and clinical characteristics were related to lack of receipt of mammography. With the passage of the Affordable Care Act, targeted interventions to reach the population subgroups less likely to receive the recommended mammography screening are essential.