Utilization of Screening Mammography in Women Before 50: Cross-Sectional Survey Results from the National Health Interview Survey.

OBJECTIVE: While the American College of Radiology recommends annual screening mammography starting at age 40 years, the US Preventive Services Task Force (USPSTF) recommends that screening mammography in women younger than age 50 years should involve shared- decision making (SDM) between clinicians and patients, considering benefits and potential harms in younger women. Using a nationally representative cross-sectional survey, we aimed to evaluate patient-reported reasons and predictors of screening mammography utilization in this age group. METHODS: Respondents aged 40-49 years from the 2018 National Health Interview Survey (NHIS) without a history of breast cancer were included (response rate 64%). Participants reported sociodemographic variables and reasons they did not engage in mammography screening within the last two years. Multiple variable logistic regression analyses were performed to evaluate the association between sociodemographic characteristics and patient-reported screening mammography use, accounting for complex survey sampling design elements. RESULTS: 1,948 women between the ages of 40-49 years were included. Of this group, (758/1948) 46.6% reported receiving a screening mammogram within the last year, and 1196/1948 (61.4%) reported receiving a screening mammogram within the last two years. The most common reasons for not undergoing screening included: "No reason/never thought about it" 744/1948 (38.2%), "Put it off" 343/1948 (17.6%), "Didn't need it" 331/1948 (16.9%), "Doctor didn't order it" 162/1948 (8.3%), and "I'm too young" 63/1948 (5.3%). Multiple variable analyses demonstrated that lack of health insurance was the strongest predictor of mammography non-engagement (p< 0.001). CONCLUSION: Deficits in shared- decision-making in women younger than 50 years related to mammography utilization exist. Radiologists may be key in addressing this issue among ambulatory care providers and patients, educating about the benefits and harms of screening younger women, particularly in racial/ethnic minorities and uninsured patients, who experience additional barriers to care and SDM discussions.

Overlap in processing advantages for minimal ingroups and the self.

Cognitive biases shape our perception of the world and our interactions with other people. Information related to the self and our social ingroups is prioritised for cognitive processing and can therefore form some of these key biases. However, ingroup biases may be elicited not only for established social groups, but also for minimal groups assigned by novel or random social categorisation. Moreover, whether these 'ingroup biases' are related to self-processing is unknown. Across three experiments, we utilised a social associative matching paradigm to examine whether the cognitive mechanisms underpinning the effects of minimal groups overlapped with those that prioritise the self, and whether minimal group allocation causes early processing advantages. We found significant advantages in response time and sensitivity (dprime) for stimuli associated with newly-assigned ingroups. Further, self-biases and ingroup-biases were positively correlated across individuals (Experiments 1 and 3). However, when the task was such that ingroup and self associations competed, only the self-advantage was detected (Experiment 2). These results demonstrate that even random group allocation quickly captures attention and enhances processing. Positive correlations between the self- and ingroup-biases suggest a common cognitive mechanism across individuals. These findings have implications for understanding how social biases filter our perception of the world.