As we enter the second week of Breast Cancer Awareness Month, it appears awareness of breast health and mammography screenings is increasingly necessary.

Only about a quarter of women age 50 to 74 had the appropriate number of lifetime mammography exams recommended in national guidelines, according to an article in "Health Services Research" published by Health Research and Educational Trust.

Fifty-nine percent of women had a mammography in the past two years, while 70 percent of women studied had at least one exam in their lifetime. Guidelines issued by the National Cancer Institute call for women age 50 to 74 to be screened every one to two years.

"Our finding that only about one-quarter of women report adhering to screening guidelines has important implications for practitioners and mammography programs and policies," said Dr. Kathryn A. Phillips, assistant professor of health services research and policy at the University of California-San Francisco, and her colleagues.

"Although the vast majority of women have had initial screening and a majority of women have had recent screening, the large drop in the percentage of women who adhere to guidelines indicates that adherence needs to become a focus of clinical, programmatic and policy efforts," they said.

They also discovered that a woman's adherence to guidelines was influenced by her involvement in shared decision-making with her physician. The study suggests that the interaction between women and their providers plays a key role in adherence. Women also were more likely to use mammography if they: were younger; had smaller families, higher education and income, and a recent Pap smear; reported breast problems; lived in areas where mammography facilities had tracking and reminder systems; and lived in areas with sufficient numbers of primary care physicians, and with higher HMO market penetration.