Table 1

Description of scientific, peer-reviewed research about the validity of self-reported mammography: Australia, Canada, Israel, the Netherlands and the USA, 1990–2017

author and
year of
Country of studyAge range (or meta-
Clinic (C), population-based (P) or other (O)NSurvey administration methodElderly
Test of
11 King,
USA50–74C (HMO)200Phone interviewNoNo
12 Loftus,
USA40+C (HMO)119MailNoNo
13 Brown,
17–79; mammography group not stated
C (HMO)162Phone interviewNoNo
14 Degnan,
USA50–74C (HMO)487 (1988), 486 (1990)Phone interviewNoYes
Conclusions about 2-year self-report: ‘Surveys that ask ‘when was your last mammogram’ will overestimate usage. Such surveys can, however, accurately estimate change in usage’.
15 Fulton-Kehoe,
USA50–75C (HMO)78MailNoNo
16 Gordon,
USA40–74C (HMO)386Phone interview and mailNoYes
Conclusions about 2-year self-report: ‘Self-reported data may overestimate the percentage of the population that has been screened and underestimate the interval since the last cancer detection procedures’.
17 Whitman, 1993USA50+C (public health department)924Phone interviewNoNo
18 Etzi,
USA50–74C (public health department van)237Phone interviewNoNo
19 Sudman,
USA50+C (HMO)32Focus groups, face-to-face interviewsNoYes
Conclusions about 2-year self-report: The ‘gross accuracy of mammogram self-report’ was 76.3%. ‘It was not possible to recommend any changes in the questions currently used in the NHIS to obtain information about…mammograms’.
20 Hiatt,
USA40–74C (HMO)687Phone interviewNoYes
Conclusions about 2-year self-report: ‘…reliance on self-report data to assess a population’s screening status relative to some goal should be questioned. Such assessment will substantially overestimate progress toward goals that have been set’.
21 Johnson, 1995USA35–65P (Native American)201Face-to-face interviewNoNo
22 Kottke,
USA40–89P1019Phone interviewNoYes
Conclusions about 2-year self-report: ‘We noted a discrepancy between the self-reported and verified rates of testing. This difference in rates suggests that the true rates may be significantly less than the self-reported rates’.
23 Montaño, 1995USA50+ (for mammography)C3281 patient chartsMailNoNo
24 Suarez,
USA40+P450Face-to-face interviewNoYes
Conclusions about 2-year self-report: Self-reports ‘Will greatly overestimate the prevalence of screening’.
25 Crane 1996 USA50+C (county health department)576Phone interview and face-to-face (<4%) interviewNoNo
26 Paskett,
USA40+P441Face-to-face interviewNoNo
27 Zapka,
USA50–74C (Western Massachusetts)392Mail or phone interviewNoNo
28 Warnecke,
USA50+C (HMO)178Not statedNoNo
29 Champion,
USA45–64O (study participants)268Face-to-face interviewNoYes
Conclusions about 2-year self-report: ‘Self-report alone may not provide accurate rates of mammography compliance. Further research is necessary with ethnic and low-income women’.
30 McGovern,
USA40–92C (county
medical centre)
477Face-to-face interviewNoNo
32 Lawrence,
USA50–70C (military)232Phone interviewNoNo
33 Thompson,
USA50–69C (public hospital)361Mail and telephoneNoNo
31 Barratt,
Australia30–69P (well women)124Phone interviewNoNo
34 Martin,
USA40+C (HMO)194Phone interviewNoYes
Conclusions about 2-year self-report: ‘…self-reports are reasonably accurate compared with medical records…’.
35 McPhee,
USA40–74P846Phone interviewNoYes
Conclusions about 2-year self-report: ‘Population estimates of breast…cancer screening rates based upon patient self-reports need to be adjusted downward, by as much as one-quarter to one-third, for low-income, ethnic women’.
36 Caplan,
USA50–80C (HMO)949Phone interviewYesYes
Conclusions about elderly and 2-year self-report: ‘The accuracy of self-reports was not related to age race/ethnicity, years since last preventive checkup, smoking status, perceived health status, or perceived risk of developing breast cancer, after controlling for all of the other variables in the model…We found that self-reported data on mammographic screening, having the most recent mammogram within a defined interval (2 years), could be used in clinical decision-making and surveillance. However, it would certainly be preferable to use medical records if they were available at a cost and level of effort that was manageable’.
‘Caution is necessary concerning the generalizability of our findings to the entire US population and other diverse populations, because of the characteristics of our study sample and setting’.
37 Caplan,
USA40–74C (HMO)480Phone interviewYesYes
Conclusions about 2-year self-report: ‘The results suggest that self-reported BRFSS [(Behavioral Risk Factor Surveillance System)] data are highly sensitive for assessing the prevalence of breast…cancer screening in this managed care population but not very specific. However, it is important to keep in mind that this study used a relatively homogenous insured managed care population composed of mainly white women, aged 40–75 years, with at least a high school education, who were either currently employed or retired. Although the results cannot be generalized to the United States population, they provide credible insight regarding the utility of the BRFSS in an important segment of the population…Our study results suggest that self-reported data ascertained using the BRFSS provide an accurate estimate of the prevalence of screening for breast…cancers in KPC [(Kaiser Permanente Colorado)] and possibly other similar managed care populations with similar enrollees. Therefore, it would seem reasonable for the BRFSS to continue to use self-reporting as the means of obtaining its data. In addition, it is reasonable and appropriate for the BRFSS to continue to use its current wording to obtain its data regarding women’s usage of mammography…’.
38 Norman,
USA40–64Cases (incident breast cancer)—C
2495 cases;
615 controls
Phone interviewNoYes
Conclusions about 2-year self-report: ‘In an interview-based case-control study of the efficacy of screening mammography, 1) estimated true prevalence of recent screening mammography adjusted for sensitivity and specificity will be slightly lower than self-reported prevalence, and 2) differential misclassification of exposure status is slight. Therefore, odds ratios will likely be biased toward the null, underestimating screening efficacy’.
39 Armstrong,
USA50–75C (Philadelphia, Pennsylvania Medicaid managed care organisation)399Phone interview and mailYesNo
Conclusions about elderly (and race): Adherence rates were not affected by age 65+ years. African–American adherence was significantly greater when measured by self-report than by administrative claims or the medical record.
40 Fiscella,
USA40+P (1996 Medical Expenditure Panel Survey)3090Face-to-face interviewNoNo
Pertinent information: ‘In the annual Household Survey conducted in 1996, women were asked ‘How long has it been since you had a mammogram’? Possible responses included ‘Within past year’, ‘Within past 2 years’, ‘Within past 5 years’, ‘More than 5 years’, and ‘Never’. Women who reported receiving one within the past year were coded as having received a mammogram. In the Medical Events Survey, women were asked to recall any medical services, events, or procedures that they received during the prior 4 months between 1996 and 1997: ‘Looking at this card, which of these services, if any, did you have during the visit’?’ Racial disparities were found for the Medical Events Survey, but not the Household Survey. Conclusion: ‘Estimates of racial, but not ethnic, disparities in mammography seem to depend on how the question is asked. These results caution against exclusive reliance on annual self-reports for monitoring disparities in preventive care’.
41 Tumiel-Berhalter,
USA40+C314Face-to-face interviewNoYes
Conclusions about 2-year self-report: ‘…self-report of recommended screening was consistently higher than medical record documentation [(% last mammogram within guidelines = 91.1% by self-report and 57.2% by chart review)]…Self-report of receipt of mammography…was consistently higher than medical record documentation of screening. Self-report misrepresented actual screening practices as identified by high sensitivity rates and low specificity rates. However, high negative predictive values suggested that asking women about their recent mammography use may be an inexpensive, easy intervention to increase screening among women currently not being screened by encouraging dialog between patient and provider about reasons for not being screened and/or other means of obtaining screens’.
42 Johnson,
USA50–94P587Phone and face-to-face interviewsNoYes
Conclusions about 2-year self-report: ‘The most interesting of our findings were those related to the intentions manipulation, which are supportive of the proposition that first asking about future intentions reduces the social desirability demands of reporting positive past behavior, thereby increasing data quality…’.
43 Fiscella,
USA65+P (Medicare Current Beneficiary Survey, 1999–2002)49 645Personal records and face-to-face interviewYesNo
Conclusions about elderly: ‘This study shows that estimates of racial/ethnic disparities, across a variety of preventive care procedures, vary depending on whether self-report or claims are used to assess them. Whether these differences reflect biases in participant report or in billing claims is unclear. These competing explanations have profoundly different policy implications, and thus warrant careful study. Future monitoring of disparities in screening will require more careful distinction of screening from diagnostic uses of preventive procedures’. Note: Results were criticised by Craig et al (please see 46 below) who stated that an error in the way results were reported ‘Inherently reduced their validity estimates, and artificially increased discordance between self-report and claims-based measures’.
44 Holt,
USA65+P (Medicare Current Beneficiary Survey)5461Personal records and face-to-face interviewYesNo
Conclusions about elderly: ‘Our findings show that self-report of mammography compared with self-report verified by claims data provide conflicting evidence of disparities in mammography, particularly among Black women. The results suggest caution in over-reliance on self-report data for estimating disparities in the receipt of preventive services. On the basis of these findings, we believe it is premature to conclude that disparities in mammography have been eliminated. Further exploration of the reasons for differences between self-report and claims information is warranted’.
9 Rauscher,
USAMeta-analysisWe calculated summary random-effects estimates for sensitivity and specificity, separately for mammography, clinical breast exam, Pap smear, prostate-specific antigen testing, digital rectal exam, fecal occult blood testing and colorectal endoscopy.
Observations and conclusions: ‘Black-White and Hispanic-White disparities in mammogram and Pap smear prevalence estimates seemed to be considerably larger than those based on the observed estimates alone…The Healthy People 2010 goals call for increasing the percentage of women adhering to national cancer screening guidelines. Healthy People 2010 calls for an increase, by 2010, in Pap smear utilization in the preceding 3 years from 92% to 97%, mammography in the preceding 2 years from 67% to 70%, annual fecal occult blood test from 35% to 50%, and colorectal endoscopy in the preceding 5 years from 37% to 50%. Results from this meta-analysis indicate that we are probably further from these goals than survey data suggest. Another broad goal of Healthy People 2010 is the reduction of disparities in health and health care utilization. Again, according to this meta-analysis, disparities in cancer screening by race/ethnicity are likely to be larger than they seem to be in national survey data. These inaccuracies need to be taken into account when interpreting progress toward the Healthy People 2010 goals of increasing utilization and reducing disparities. Because the NHIS is the major source of data on cancer screening used for tracking prevalence in the U.S. population, validation studies should be undertaken for a sample of respondents within the NHIS, and designed with enough power to detect meaningful differences in sensitivity and specificity for different racial/ethnic and socioeconomic groups’. Summary: ‘When estimates of self-report accuracy from this meta-analysis were applied to cancer-screening prevalence estimates from the National Health Interview Survey, results suggested that prevalence estimates are artificially increased and disparities in prevalence are artificially decreased by inaccurate self-reports…National survey data are overestimating cancer-screening utilization for several common procedures and may be masking disparities in screening due to racial/ethnic differences in reporting accuracy’.
45 Baron-Epel,
Israel52–74C (Maccabi Health
1536Phone interviewNoYes
Conclusions about 2-year self-report: Agreement between self-reported mammography and claims records depends on cultural and socioeconomic factors.
46 Craig,
USA65+P (Medicare Current Beneficiary Survey, 1991–2006)15 537Personal records and face-to-face interviewYesNo
Conclusions about elderly: ‘In this study, the likelihood that a screened woman reports screening decreases by 1.8% per month of recall and by an additional 8.7% if the screening event occurred in a different calendar year. The combined evidence suggests that over a quarter of older women failed to report mammography use a year after screening. In their analysis of Medicare Current Beneficiary Survey responses, Fiscella, Holt and colleagues stated that the mammography question’s referent period was ‘since last year,’ which is inaccurate…’.
47 Cronin,
USA40–79PNot statedTelephone interviewYesYes
Conclusions (and observations) about elderly and 2-year self-report: ‘Self-report estimates of mammography use in the prior two years from the Vermont BRFSS are 14–27 percentage points higher than actual screening rates across age groups. The differences in NHIS screening estimates from models are similar for women 40–49 and 50–59 years and greater than for those 60–69, or 70–79 (27 and 26 percentage points vs. 14, and 14, respectively). Over reporting is highest among African American women (24.4 percentage points) and lowest among Hispanic women (17.9) with white women in between (19.3). Values of sensitivity and specificity consistent with our results are similar to previous validation studies of mammography. Conclusion: Over-estimation of self-reported mammography usage from national surveys varies by age and race/ethnicity. A more nuanced approach that accounts for demographic differences is needed when adjusting for over-estimation or assessing disparities between populations’.
10 Howard,
USAMeta-analysis‘Objectives To conduct a systematic review and meta-analysis of the accuracy of self-reported Pap smear and mammography screening compared to medical record…About 37 articles were reviewed and accuracy indices of self-report were calculated. Meta-analysis with random effects was used. Study heterogeneity was investigated and meta-regressions were done including in the models those factors that were hypothesized, a priori, to potentially explain heterogeneity. Results Pooled sensitivity and specificity…for mammography [recall] were 94.9% (95% CI; 93.4%–96.4%) and 61.8% (95% CI; 54.1%–69.5%)…There was significant heterogeneity for all indices. Stratifying by the study population source (population versus clinic-based), population characteristics (minority or low socio-economic status versus not), length of recall (within past 12 months versus longer), and expected completeness of the medical record (authors searched radiology or pathology reports of all likely facilities women may have attended, versus studies that did not) did not eliminate heterogeneity’.
Conclusions about 2-year self-report: ‘Women tend to over-report their participation in…mammography screening in a given timeframe. The pooled estimates should be interpreted with caution due to unexplained heterogeneity’.
5 Njai,
USAMeta-analysis‘We adjusted BRFSS mammography use data for age by using 2000 census estimates and for misclassification by using the following formula: (estimated prevalence − 1 + specificity) / (sensitivity + specificity − 1). We used values reported in the literature for the formula (sensitivity = 0.97 for both black and white women, specificity = 0.49 and 0.62, respectively, for black and white women)…
After adjustment for misclassification, the percentage of women aged 40 years or older in 1995 who reported receiving a mammogram during the previous 2 years was 54% among white women and 41% among black women, compared with 70% among both white and black women after adjustment for age only. In 2006, the percentage after adjustment for misclassification was 65% among white women and 59% among black women compared with 77% among white women and 78% among black women after adjustment for age only’.
Conclusions about 2-year self-report: ‘Self-reported data overestimate mammography use — more so for black women than for white women. After adjustment for respondent misclassification, neither white women nor black women had attained the Healthy People 2010 objective (≥70%) by 2006, and a disparity between white and black women emerged’.
48 Pijpe,
The Netherlands<30 to 50+O (The Netherlands Collaborative Group on Hereditary Breast Cancer)177MailNoPartial
(last 5 years)
Conclusions (and observations) about 2-year self-report: ‘Although cases more often tended to underestimate their exact age at first mammogram, whereas unaffected carriers tended to overestimate, this difference in the direction of inaccuracy was not statistically significant…Accuracy of age at last mammogram was moderate and improved to excellent for agreement within 1 year. Carriers tended to underreport the time since last mammogram (‘telescoping’) and over-reported the number of mammograms. Conclusion: Accuracy of self-reported lifetime mammography history in carriers highly varied, depending on the measure under investigation. However, the extent of the observed misclassification was small and mostly non-differential’.
49 Larouche,
Canada21–81O (participants in the INHERIT* Study307Self-administeredYesNo
Conclusions about elderly: ‘Overall, the agreement between self-reports and administrative data was 88% (j = 0.74). [although accuracy decreased significantly with increasing age]…Self-report overestimates the use of mammography, mainly because women tend to minimize the elapsed time since their last mammography. Self-reports should be used cautiously to assess adherence to mammographic screening following BRCA1/2 testing’.
50 Son,
USA40+O (participants in the ‘Women Be Healthy’ programme)155Face-to-face and computer-assisted interviewYesNo
Conclusions about the elderly: There was no association between age and accuracy of self-report. ‘Clinicians and researchers are cautioned to corroborate self-reported data with other sources for patients and research participants with intellectual disability’.
51 Allgood,
USA40 to 65+P (venue-based sampling in two low-income communities on the west side of Chicago)1221Comparison of self-reported survey responses to medical recordsYesYes
Conclusions: Across all categories of all sociodemographic variables examined, mammography use estimates based on self-reports were considerably larger than the corresponding estimates based on medical record documentation. Overall impact: ‘Relying on known faulty self-reported mammography data as a measure of mammography use provides an overly optimistic picture of utilization, a problem that may be exacerbated in vulnerable minority communities’ (p2).
52 Nandy,
USA40–74O (Korean-American women recruited from religious organisations)97Self-report on written survey versus medical recordNoNo
  • *Interdisciplinary Health Research International Team on Breast Cancer Susceptibility.

  • BRFSS, Behavioral Risk Factor Surveillance System; HMO, health maintenance organisation; NHIS, National Health Interview Survey.