First mammogram - what women want!

Women in their 40s considering their first screening mammogram want information on potential harm and benefits and want to participate in the decision-making process, according to a study in the June 27 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

Routine screening mammograms are often recommended for women beginning at age 40, but primary care clinicians are encouraged to inform their patients of the benefits and potential harms of the procedure and to invite them to share in the decision making, according to background information in the article. Previous studies suggest that women overestimate the risk of breast cancer and the benefits of screening and are unaware of possible harm, the authors write. In addition, little is known about how much involvement women want in decision making about initiating screening.

Larissa Nekhlyudov, M.D., M.P.H., of Harvard Medical School, and colleagues surveyed women age 40 to 44 scheduled for their first screening mammogram. Women were asked to rate the importance to them of elements of information about the mammogram and their preferences for involvement in decision making, ranging from making the decision alone to having the decision made by her clinician alone.

Most of the 96 women surveyed preferred their primary care practioner as their main source of information about the screening mammogram. The women were particularly interested in logistical information before their mammogram, such as which steps to take following an abnormal mammogram (89 percent), how they would be contacted (75 percent) and how quickly (71 percent). They were also interested in potential harms, of false-positive results (84 percent) and false-negative results (82 percent). Being informed about the benefits of screening and about breast cancer risk were also rated as important. Information about pain and cost were desired less often.

When asked about their preferences for involvement in screening decisions, seven (eight percent) preferred that the decision be made by the woman herself, 35 (38 percent) preferred that the decision be made by the woman after considering her medical professional's opinion, 43 (46 percent) preferred that the woman and her clinician share the decision, and, eight (nine percent) preferred that the clinician make the screening decision. None preferred the clinician to 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 authors conclude. "Effective methods for communicating desired information and involving women in the decision-making process should be developed. It needs to be determined when the information should be provided and by whom."