What Factors are Associated with Where Women Undergo Clinical Breast Examination? Results from the 2005 National Health Interview Survey.

Background: Recent studies have suggested that clinical breast examination (CBE) rates may vary according to patient, provider and health care system characteristics.

Objective: To examine the locations where U.S. women received a CBE and other general preventive health, and to examine predictors of location of receipt of general preventive health care (including a recent CBE).

Design: Age-specific and age-adjusted rates of CBE use were calculated using Statistical Analysis Software (SAS) and SUDAAN. A multivariate analysis was carried out using logistic regression techniques.

Participants: Women aged 40 years and older (n = 10,002) who participated in the 2005 National Health Interview Survey (NHIS).

Measurements: Recent CBE use was defined as within the past two years.

Results: Among all women, 65% reported a CBE within two years. The highest rate was found among women receiving routine care from doctors' offices and health maintenance organizations (HMOs) (68.5%). CBE use was somewhat lower among women receiving routine care from clinics or health centers (62.9%), and substantially lower among women receiving care from "other" locations (28.4%) or not reporting receiving preventive care (25.3%). Low income women (p < .01) and those with less than a high school education (p < .01) are more likely to go to a hospital than higher SES women. Women with health insurance are much more likely than women without health insurance to go to a doctor's office or HMO, and less likely to be seen at a clinic or health center (p < .01 in both instances). In multivariate analysis, women who received routine care in a location other than a clinic or health center, doctor's office or HMO, or hospital outpatient department (OPD) were less likely to have received a CBE within the past two years (adjusted OR = 0.4, 95% CI = 0.3, 0.7) compared to those at a doctor's office or HMO.

Conclusions: After adjusting for patient factors, clinics/health centers and hospital OPDs performed as well as doctors' offices/HMOs in delivering CBE. However, women receiving care in other locations were less likely to report CBE.