Research paper 43 Family history of breast cancer and compliance with mammography in Israel: findings of the National Health Survey 2003–2004 (EUROHIS) Lital Keinan-Boker a,b , Orna Baron-Epel a,b , Noga Garty a and Manfred S. Green a,c A positive family history of breast cancer is an established risk factor for the disease. In Israel, screening is recommended annually for high-risk women aged Z 40 years and biennially for average-risk women aged Z 50 years. The current study aimed to assess the effect of having a positive breast cancer family history on performing screening mammography in Israeli women. This study is a cross-sectional survey based on a random sample of the Israeli population, conducted in 2003. The study was carried out by means of telephone interviews that included questions on the use of preventive medical services. The current study population consists of 1605 Israeli women aged 40–74 years. A positive family history for breast cancer was reported by 153 (9.5%) of the participants. A mammogram in the previous year was reported by 43.1 and 24.7% of the positive and negative family history subgroups, respectively (P < 0.0001). Rates increased with age. Among women with a positive family history, only being married was a significant correlate for a mammography in the previous year. Over 60% and around 55% of high-risk women aged 40–49 and Z 50 years, respectively, are inadequately screened for breast cancer. Screening rates are not optimal in the average-risk group as well. European Journal of Cancer Prevention 16:43–49  c 2007 Lippincott Williams & Wilkins. European Journal of Cancer Prevention 2007, 16:43–49 Keywords: Arabs, breast cancer, compliance, early detection, family history, Israel, Jews, mammography, screening a Israel Center for Disease Control, Ministry of Health, Gertner Institute, Tel Hashomer, Ramat Gan, b School of Public Health, Faculty of Social Welfare and Health Studies, University of Haifa, Carmel Mountain, Haifa and c Department of Epidemiology and Preventive Medicine, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel Correspondence to Lital Keinan Boker, MD, PhD, MPH, Israel Center for Disease Control, Gertner Institute, Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel Tel: + 972 3 7371500; fax: + 972 3 5349881; e-mail: lital.k@icdc.health.gov.il Received 7 November 2005 Accepted 3 March 2006 Introduction While reported breast cancer incidence in Israel is relatively high among Jewish women and low among Arab women (The Israeli National Cancer Registry, 2002), it has been increasing among both groups during the last decade, partly owing to increased detection by screening (Ifrah, 1999). Screening mammography has been shown to reduce mortality and many countries have developed guidelines for early detection of breast cancer and implemented programs accordingly (Boyle et al., 1995; Kerlikowske et al., 1995; Shapiro et al., 1998). The Ministry of Health, National Oncology Council and the Cancer Association in Israel recommend that women aged 50–74 years at an average risk for the disease should have a screening mammogram every other year, while high-risk women [i.e. those with a positive family history (FH) of breast cancer] should be screened annually, starting at the age of 40 years (Israel Cancer Association, 1995). Implementing these guidelines within the national health system was achieved by incorporating screening mammo- graphy according to these indications into the basket of services provided by the national health insurance law. This, however, did not necessarily achieve a high level of compliance with screening among the target population (Harris et al., 1992; Mettlin et al., 1992a, b); in a national telephone health survey performed on a random sample of the Israeli population during the year of 1997, 972 Jewish and 233 Arab women were interviewed. Ever having a mammogram was reported by 61 and 21% of the Jewish and the Arab participants, respectively (Farfel and Yuval, 1999). In another national survey of women’s health carried out in 1998, 52 and 24% of the Jewish and Arab participants, respectively, reported attending mam- mography in the last 2 years (Ifrah, 1999). In an attempt to increase levels of attendance, women aged 50–74 years who are eligible for the national breast cancer early detection program are now personally invited by their Health Maintenance Organizations through a mailed invitation, to perform a screening mammogram every other year. The national postal invitation program, however, does not include women younger than 50 years of age who may be at a higher than average risk for the disease because of a positive FH, or other risk factors. In order to follow the national guidelines and perform an annual screening mammogram, which is fully covered by the national health insurance, these women have to actively refer to their physicians. 0959-8278  c 2007 Lippincott Williams & Wilkins Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.