Patients have high expectations about breast cancer screening mammography

A substantial proportion of women have beliefs about their personal risk of breast cancer, and expectations about the performance of mammography that are abnormally high or unrealistic, according to a survey conducted at University of Michigan Health Systems in Ann Arbor, Michigan.

A survey was administered to women who came to an outpatient clinic for screening mammography. The participants were 397 women ranging from 40-83 years old. The responses to the survey questions showed that 16% thought that their personal risk of breast cancer was 50% or higher. These numbers compare to American Cancer Society reports that indicate that the chance of a woman having invasive breast cancer some time during her life is about 1 in 8.

The survey also found that 20.6% of the women agreed with the statement 'mammograms detect all breast cancers' and 11.4% were neutral about this statement. "Women have high expectations of mammography because patients in general (not specifically women), tend to have a view of all medical tests being yes or no, 'positive' or 'negative'; the general public as well as some health care professionals do not completely understand concepts of accuracy, sensitivity and specificity, false negatives, and false positives," said Marilyn Roubidoux, MD, co-investigator of the study. "People assume that if a mammogram can detect cancer the size of a pin, then it can detect all cancers bigger than a pin. The reality is much more complicated than that," she said.

Most of the women (94%) had had a prior mammogram; 14.1% had prior benign biopsy. Eighty-four percent of the respondents had one year of post high school education, 55% were college graduates, and 23% had graduate degrees.

"The purpose of the study was to identify the significant predictors of repeat mammography behavior. Specifically looking at the relative impact of the pain experience, emotional distress and anxiety, and satisfaction with the health care experience," said Tricia Tang, PhD, who was the principal investigator and the designer and administrator of the survey. "By understanding better which factor carries more weight, we can develop interventions, be it patient-based, provider-based, or clinic operations based."

"As stated, women in this study were highly educated and likely well informed about procedures such as mammograms. With more information, expectations are more accurate, thereby minimizing the negative physical and emotional aspects associated with this type of procedure," said Tang.

"The results in the survey were expected," said Marilyn Roubidoux, MD, co-investigator. "After working with patients for many years and doing their biopsies, their beliefs about mammography are revealed in conversations and these now are shown in a more objective way in the survey."

The full results of this study will be presented on Thursday, May 4, 2006 during the American Roentgen Ray Society annual meeting in Vancouver, BC.