Factors associated with use of breast cancer screening services by women aged ≥ 40 years in Korea: The Third Korea National Health and Nutrition Examination Survey 2005 (KNHANES III)

Background: Despite evidence that breast cancer screening reduces morbidity and mortality, until recently most women have not undergone regular mammogram examinations in Korea. We aimed to identify factors associated with use of breast cancer screening services. Methods: The Health Promotion Knowledge, Attitude and Practice survey (HP-KAP survey) is part of the Third Korea National Health and Nutrition Examination Survey 2005 (KNHANES III), a nationwide health survey in Korea. Of 7,802 individuals who participated in the HP-KAP survey, 4,292 were female. Of these, 2,583 were women aged at least 40 years and without a history of breast cancer; these women were included in this study. Information about breast cancer screening participation was obtained from the responses to questionnaires. The overall rate of regular breast cancer screening was measured. Factors that affect participation in a breast cancer screening program were identified using multiple logistic regression analysis. Results: Among women aged at least 40 years, 30.4% complied with breast screening recommendations. Age of at least 65 years (adjusted odds ratio, aOR 0.61, 95% Cl: 0.42-0.88), education level (no [ref], elementary school [aOR 1.51, 95% Cl: 1.06-1.47], middle/high school [aOR 1.99, 95% Cl: 1.36-2.92], university/higher [aOR 2.73, 95% Cl: 1.71-4.35]), private health insurance (aOR 1.42, 95% Cl: 1.71-4.35), attitude towards screening tests (aOR 0.18, 95% Cl: 0.14-0.23), self-reported health status of 'fair' (aOR 1.26 95% Cl: 1.00-1.58), and smoking (aOR 0.52, 95% Cl: 0.35-0.79) were associated with the rate of regular breast cancer screening Conclusions: To increase the nationwide breast cancer screening rate, more attention should be given to underrepresented groups, particularly the elderly, those with a low education level, smokers, and those with a negative attitude towards screening tests. These issues highlight the need for a new emphasis in health education, promotional campaigns and public health policy aimed at these underrepresented groups.