Predictors of mammography screening use among women with MS
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Breast cancer is a leading cause of mortality among women in the United States. Women with chronic disabling conditions such as multiple sclerosis (MS) are less likely to participate in routine mammography screening than women without disabilities due to multiple barriers. Underuse of mammography screening may lead to a diagnosis of a later stage breast cancer and consequently higher breast cancer mortality rate. This study examined the influence of several factors including, severity of MS-related functional limitations, demographic characteristics, family history of breast cancer, beliefs related to mammography screening and breast cancer, and personal resources on usual screening mammography in a sample of women with MS. The conceptual framework guiding this study was synthesized from The Explanatory Model of Health Promotion and Quality of Life in Chronic and Disabling Conditions and the Health Belief Model. Data from an ongoing longitudinal study (R01NR003195) focused on health promotion of persons with MS were combined with primary data for this prospective descriptive correlational study. The nonprobability sample consisted of 274 women ages 39-85 years who were primarily White (92%), married (66.1%), and unemployed (64.1%) with a 22 year average length of diagnosis with MS. Data were collected over two years using a mailed survey. Descriptive statistics and hierarchical logistic regression analyses were used to address the research questions. The annual mammography rate in this sample was 62%. Perceived susceptibility to breast cancer (AOR = 3.0, p < .05), family history (AOR = 2.5, p < .05), economic adequacy (AOR = 1.6, p < .05), and perceived barriers to mammography (AOR = .98, p < .05) significantly predicted mammography use, adjusted for severity of functional limitations. Though severity of limitations was negatively associated with mammography, it was not a significant predictor in the overall model. These findings suggest that for women with chronic disabling conditions, health beliefs, family history, and personal resources influence mammography screening. Clinicians need to continue to eliminate the barriers to mammography screening to improve screening and reduce overall breast cancer mortality rate in this vulnerable population.