Although mammography is effective in decreasing breast cancer mortality, an age-related decline in mammography use continues. The purpose of this cross-sectional correlation study was to determine what combination of predisposing, enabling, and need variables best predicted mammography utilization in women $ge$50 years.

The convenience sample of 1083 women church members was 78% white, 22% African American, with a mean age of 65.7 years. The mean educational level was 13.6 years; mean income was $30,000--$40,000. Data were collected with a mailed survey developed and pilot-tested by the investigator, using questions from prior mammography and health services utilization research. Utilization rates for one-time and recent mammography were 84.7% and 48.8%; three-and five-year adherence rates were 20.6% and 12.8%.

Predisposing and enabling variables with significant odds ratios were combined in logistic regression equations. Across categories of mammography use, knowledge, annual Pap tests, and willingness to pay $ge

Benefits, knowledge, intention, family history of breast cancer, and internist as physician predicted increased likelihood of ever having mammography, while susceptibility, control, and middle income predicted decreased likelihood. Increased likelihood of having a mammogram one year ago was predicted by knowledge, intention, white race, physician recommendation for mammography, physician checkup last year, annual Pap tests, OB/Gynecologist as physician, and willingness to pay $ge

Greater likelihood of three-year adherence to mammography guidelines was predicted by benefits, knowledge, annual Pap tests, OB/Gynecologist as physician, willingness to pay $ge

Results suggested the need to incorporate mammography into regular medical and health care, make lower cost mammography more available to older and minority women, and increase older women's knowledge about breast cancer and mammography guidelines. To meet the Year 2000 goal of annual mammography for 80% of women $ge$50 years, concerted efforts must be directed toward promoting adherence to mammography guidelines.