American women's concerns about their risk of breast cancer has subsided in the past six years and few can cite either the age or frequency at which mammograms are recommended - signs of the ongoing challenge in keeping breast cancer awareness at the forefront of public attention.
While mammograms are common, this new ABC News poll finds that one in four women age 50 and older, the now-recommended age, don't report ever having had one. There are particular shortfalls in mammogram screening among lower-income women and nonwhites. Nearly half of all women, moreover, say they've never discussed breast cancer with a doctor. And fewer now than six years ago report doing self-examinations.
On an issue of recent debate, just more than half, 52 percent, say they'd be interested in being tested to find if they have the gene associated with a high risk of breast cancer. But strong interest wanes to 28 percent - and, even if they carry the gene, most say they'd be disinclined to opt for a preventive mastectomy, the path taken recently by the actress Angelina Jolie.
In many of these, age and having had a close relative diagnosed with breast cancer influence women's attitudes and behavior. Concern about risk, talking with a doctor and having had a mammogram all rise among women who have had a close relative diagnosed, and the latter two increase, as well, among those who've reached middle age.
This survey was produced for ABC by Langer Research Associates in support of division-wide ABC News coverage of breast cancer awareness, "ABC Goes Pink," airing beginning Oct. 1 on ABC's Good Morning America.
CONCERN - In an ABC survey six years ago, 61 percent of women expressed concern about their risk of getting breast cancer; that compares with 46 percent now. (This wasn't asked among the 2 percent who say they've been diagnosed with the disease.) The shift occurred largely among young women, with a 22-point drop in concern among those younger than 40.
While reasons for the shift aren't clear, some possibilities suggest themselves. Younger women may have modified their risk assessment after a federal panel in 2009 relaxed the recommended starting age and frequency for mammograms and cast doubt on the usefulness of self-examinations, recommendations that may be passed on by care providers. A decline in self-exams may be producing fewer false alarms. Less use of hormone therapy has been linked to a decline in breast cancer prevalence. Concern may have been heightened in 2007 amid coverage of ABC News anchor Robin Roberts' breast cancer diagnosis and surgery. Some women simply may be more focused now on other issues, including other increasingly publicized health problems or the economic woes that have dominated public concerns since 2008. Finally, increased confidence in treatment, though not measured in this survey, could inform decreased concern about diagnosis.
Regardless, there's a sharp difference among some groups, with family history the biggest factor. Among women who've had a close relative diagnosed with breast cancer, 62 percent are worried about their own risk, compared with 40 percent of those without a family history of the disease.
Concern can be a motivator in some cases; women who express worry about their risk of breast cancer are more apt than others to have spoken with a doctor about it, as well as to have an interest in genetic testing. But concern is not a strong factor in having had a mammogram; instead that's chiefly related to age, family history and income.
MAMMOGRAMS - Fifty-six percent of all women report having had a mammogram, rising sharply to 73 percent of those age 40 and up, and 81 percent of those age 40 and older who've had a relative diagnosed with the disease. (Of all women age 40 and up, 64 percent in this survey say they've had a mammogram specifically in the past two years, similar to the 66.5 percent estimate from the U.S. Centers for Disease Control's 2010 National Health Interview Survey.)
Doubt about the need for screening is a factor as well. Asked the main reason they haven't had a mammogram in the past two years, those women by a wide margin are most apt to say they simply don't feel they need one. Being too young is next most-cited, albeit at some distance, and about one in 10 apiece say either that they're too busy or it's too costly.
In addition to age and family history, screening and discussions with doctors are highly related. Among women who've discussed breast cancer with a doctor, 67 percent say they've had a mammogram, vs. 44 percent among those who haven't had such a discussion. (It's not clear whether that conversation prompted the screening test, or followed it; likely some of both.)
Income and race are additional factors, reflecting more limited opportunities for medical care and testing among economically disadvantaged groups. Sixty-one percent of white women report having had a mammogram, vs. 46 percent of racial and ethnic minorities. And it's 64 percent among those with incomes of $40,000 or more, vs. 45 percent of those earning less than $25,000 a year.
OTHER STEPS - Among other breast-cancer screening steps, a quarter say they've done self-exams, down from 39 percent six years ago; and about two in 10 mention having had a doctor's checkup that did not include a mammogram, down from 37 percent. It's not clear if these activities have in fact lessened or just become less top-of-mind. They're covered in an open-ended question inviting respondents to mention any steps they've taken, and fewer this year mentioned multiple items.
At the same time, in November 2009, the U.S. Preventive Services Task Force recommended against teaching breast self-exams, citing studies indicating that they led to more mammograms and biopsies but no reduction in mortality rates. This was in the same report in which the task force raised the age and lessened the frequency of recommended mammograms.
WHEN, HOW OFTEN - Few women carry the task force's recommendations around in their heads - possibly because other sources, such as the American Cancer Society, have maintained the previous guidelines. Asked if the recommend age to start getting mammograms is 30, 40, 50 or 60, just 10 percent select the task force's answer, 50; many more, 43 percent, say it's 40, the previous recommendation. And an additional 43 percent say age 30.
Similarly, asked how often mammograms are recommended - every one, two, three or four years - just 23 percent select the response that reflects the task force's recommendation, biennially. Sixty-five percent say they should be done annually, again the previous recommendation.
GENETIC - Finally, women divide fairly closely, 52-46 percent, on whether they'd be interested in being tested for the gene that indicates the likelihood of getting breast cancer. (Interest, it should be noted, is a low bar.) This climbs in particular with levels of worry; among women who are very or somewhat concerned about getting breast cancer, 69 percent are interested in the genetic test, vs. 38 percent of those concerned less or not at all. Also, interest reaches 62 percent among those with a relative diagnosed, vs. 49 percent among others.
If they were tested and found to have the gene, 58 percent of women say they'd be inclined to wait and see if they develop breast cancer; as noted, many fewer, 28 percent, think they'd follow Angelina Jolie's path and have a preventive mastectomy. Fourteen percent can't say how they think they'd react in that difficult situation.
METHODOLOGY -This ABC News poll was conducted by landline and cell phone Sept. 13-19, 2013, in English and Spanish, among a random national sample of 504 women. Results have a margin of sampling error of 5.5 points. The survey was produced for ABC News by Langer Research Associates of New York, N.Y., with sampling, data collection and tabulation by SSRS/Social Science Research Solutions of Media, Pa.