Women want to make an informed decision about when to start having screening mammograms together with their doctor after a full discussion of the benefits and risks of the procedure, according to a new survey.
Most national guidelines recommend routine breast cancer screening for women using a mammogram starting at age 40. Yet researchers found that women want to be involved in making the decision on when to start screening. A screening mammogram is an X-ray of the breast used to detect breast changes in women who have no signs of breast cancer.
In the study, 91 percent of women surveyed wanted their primary care physician to be their source of information regarding screening mammograms. The women were especially interested in knowing what will happen if the test results have an abnormal finding.
Mammograms can be a stressful experience for any woman; some women tend to overestimate the risk of breast cancer. But failure to get the screening test can only increase the risk of breast cancer by allowing the cancer to go undetected. Few studies have looked at how much women want to be involved in the decision to start breast cancer screening.
In the study, researchers surveyed 96 women aged 40-44 who had an appointment for their first mammogram.
The women were asked to rate the importance to them of various pieces of information about the mammogram and the decision-making process.
Women Want Mammogram Logistics
The results showed that most women wanted to make a decision about a screening mammogram after considering their doctor's opinion (38 percent) or together with their doctor (46 percent). Less than 10 percent wanted to make the decision on their own.
Researchers also found that women were particularly interested in finding out logistical information about mammography screening results.
— 89 percent wanted to know what the next steps would be in case of an abnormal mammogram result.
— 75 percent wanted to know how they would be contacted with their mammogram results.
— 71 percent wanted to know how quickly they'd be contacted.
Most women also wanted to know about the potential risks of mammograms, including the potential for false abnormal results (84 percent) and the potential for the test to miss abnormalities (82 percent).
Pain and cost associated with mammograms were the least desired items of information that researchers asked about, with less than two-thirds of the women citing them as top concerns.
Information about pain and cost were desired less often.
When asked about their preferences for involvement in screening decisions:
8 percent preferred that the decision be made by the woman alone. 38 percent preferred that the decision be made by the woman after considering her medical professional's opinion. 46 percent preferred that the woman and her clinician share the decision. 9 percent preferred that the clinician make the screening decision.
None preferred that the clinician make all medical decisions.
"Women have specific information needs before initiating screening mammography, including the logistics, harms, and benefits, and prefer to participate in the decision-making process," the researchers conclude.
"Effective methods for communicating desired information and involving women in the decision-making process should be developed," they write. "It needs to be determined when the information should be provided and by whom."
SOURCE: Nekhlyudov, L. Archives of Internal Medicine, June 27, 2005; vol 165: pp 1370-1374.