Studies Show Who Seeks Mammography and Why

NEW ORLEANS—After years of hearing about the benefits of mammog-raphy screening, many women still resist the test. A number of posters at the annual meeting of the American Society of Preventive Oncology (ASPO) examined the question of who gets screened, who doesn’t, and why.

One finding emerged from two studies: Specific worries about breast cancer are a motivating factor for many women who seek mammography.

Previous research has suggested that anxiety and depression are related to nonadherence to health protective regimens, while specific cancer-related worries may initiate health-protective behavior. Researchers from the Fox Chase Cancer Center, Philadelphia, sought to distinguish between the different effects on health behavior of generalized anxiety and cancer-specific concerns.

The study, reported by Michael Diefenbach, PhD, included 670 women undergoing diagnostic assessment and counseling because of a familial risk for breast cancer. Patients were interviewed prior to program enrollment and at a 12-month follow-up visit.

Higher levels of cancer-specific worries at intake into the study predicted future mammography use, controlling for age and family history. But depressive and anxious moods were not significantly associated with adherence to mam-mography. Correlations among cancer worry, depressive mood, and anxious mood were low, Dr. Diefenbach reported at the meeting.

Who Do Women Listen to About Mammography?

Although breast cancer advocacy groups, with their media campaigns and networks of volunteers, play an important role in educating women about early detection, a study from the Medical University of South Carolina, Charleston, found that a mammography recommendation from a health care professional carries more weight.

At three mammography clinics, 749 women were surveyed to assess their likelihood of compliance with recommendations from different messengers.

Nearly all women said they would likely comply with a physician’s recommendation, Donna Daniel, PhD, reported, and acceptance of nurses’ recommendations was also high (79% to 90%).

However, the likelihood that women would follow a recommendation from a volunteer (32% to 51%) or media campaign (35% to 49%) was significantly lower.

Dr. Daniel noted that no racial or educational differences were observed in the women’s responses. Women with a high school education and those with college degrees both said they would be more likely to follow a physician’s recommendation.

A larger study from the University of Massachusetts Medical School, Worcester, included 2,507 women identified as underutilizers of mammography screening, from two HMOs.

Led by project director William Haddad, PhD, the researchers interviewed these “committed underutilizers” to determine their prior mammography use, risk of developing breast cancer, attitudes toward breast cancer, sociodemographic factors, and intention to utilize mam-mography screening sometime in the next 24 months.

Women characterized as “definitely planning” to get screened were significantly younger and better educated, were three times more likely to work outside the home, and were earning a higher income than the women who were less committed to mammography.

Three fourths of women in the “definitely planning” group, for example, earned $40,000 or more, compared with only 14% in the “thinking about but not planning” group and about 14% in the “not planning” group, Dr. Haddad said.

In multiple regression analysis, variables significantly associated with intention to be screened included prior utilization, worry about breast cancer, fear of learning one has breast cancer, and perceived vulnerability.

These factors distinguished three groups of women who were not planning to have mammography: (1) Those who had never considered mammography, (2) those who had decided against it, and (3) those who remained undecided.

Women who had never considered mammography were most likely never to have had one and not to be worried about breast cancer, Dr. Haddad said. Those who had decided against mammography were also likely not to be worried about breast cancer. Those who were still undecided reported the highest level of worry about breast cancer and fear of the results of mammography.