Advertisement

Journal of General Internal Medicine

, Volume 18, Issue 3, pp 182–189 | Cite as

Beliefs and expectations of women under 50 years old regarding screening mammography

A qualitative study
  • Larissa NekhlyudovEmail author
  • Dennis Ross-Degnan
  • Suzanne W. Fletcher
Original Articles

Abstract

OBJECTIVE: Because shared decision making has been recommended for screening mammography by women under age 50, we studied women’s decision-making process regarding the procedure.

DESIGN: Qualitative research design using in-depth semi-structured interviews.

PATIENTS: Sixteen white and African-American women aged 38 to 45 receiving care at a large New England medical practice.

MEASUREMENTS AND MAIN RESULTS: We identified the following content areas in women’s decision-making process: intentions for screening, motivating factors to undergo screening, attitudes toward screening mammography, attitudes toward breast cancer, and preferences for information and shared decision making. In our sample, all women had or intended to have a screening mammogram before age 50. They were motivated by the awareness of the recommendation to begin screening at age 40, knowing others with breast cancer, and a sense of personal responsibility for their health. Participants feared breast cancer and thought the benefits of screening mammography far outweighed its risks. Women’s preferences for involvement in decision making varied from wanting full responsibility for screening decisions to deferring to their medical providers. All preferred the primary care provider to be the main source of information, yet the participants stated that their own providers played a limited role in educating them about the risks and benefits of screening and the mammography procedure itself. Most of their information was derived from the media.

CONCLUSIONS: The women in this study demonstrated little ambivalence in their desire for mammography screening prior to age 50. They reported minimal communication with their medical providers about the risks and benefits of screening. Better information flow regarding mammography screening is necessary. Given the lack of uncertainty among women’s perceptions regarding screening mammography, shared decision making in this area may be difficult to achieve.

Key words

breast cancer screening mammography decision making 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Eddy DM. Clinical decision making: from theory to practice. Anatomy of a decision. JAMA. 1990;263:441–3.PubMedCrossRefGoogle Scholar
  2. 2.
    Sox HC. Screening mammography in women younger than 50 years of age. Ann Intern Med. 1995;122:550–2.PubMedGoogle Scholar
  3. 3.
    Consensus Statement NIH. Breast cancer screening for women ages 40–49. J Natl Cancer Inst. 1997;89:1015–20.CrossRefGoogle Scholar
  4. 4.
    Olsen O, Gotzsche PC. Cochrane review on screening for breast cancer with mammography. Lancet. 2001;358:1340–42.PubMedCrossRefGoogle Scholar
  5. 5.
    Kolata G. Study sets off debate over mammograms’ value. The New York Times. December 9, 2001:A1.Google Scholar
  6. 6.
    Crabtree F, Miller WL, eds. Doing Qualitative Research. Newbury Park, Calif: Sage Publications; 1992;12:1–2.Google Scholar
  7. 7.
    Giacomini MK, Cook DJ, for the Evidence-Based Medicine Working Group. User’s guides to the medical literature: XXIII. Qualitative research in health care A. Are the results of the study valid? JAMA. 2000;284:357–62.PubMedCrossRefGoogle Scholar
  8. 8.
    Degner LF, Kristjanson LJ, Bowman D, et al. Information needs and decisional preferences in women with breast cancer. JAMA. 1997;277:1485–92.PubMedCrossRefGoogle Scholar
  9. 9.
    O’Connor AM, Tugwell P, Wells GA. A decision aid for women considering hormone therapy after menopause: decision support framework and evaluation. Patient Educ Couns. 1998;33:267–79.PubMedCrossRefGoogle Scholar
  10. 10.
    Connelly MT, Ferrari N, Hagen N, Inui TS. Patient-identified needs for hormone replacement therapy counseling: a qualitative study. Ann Intern Med. 1999;131:265–8.PubMedGoogle Scholar
  11. 11.
    Chan Y, Sulmasy DP. What should men know about prostate-specific antigen screening before giving informed consent? Am J Med. 1998;105:266–74.PubMedCrossRefGoogle Scholar
  12. 12.
    Wolf AM, Philbrick JT, Schoerling JB. Predictors of interest in prostate-specific antigen screening and the impact of informed consent What should we tell our patients? Am J Med. 1997;103:308–14.PubMedCrossRefGoogle Scholar
  13. 13.
    Silverman E, Woloshin S, Schwartz LM, Byram SJ, Welch HG, Fischhoff B. Women’s views on breast cancer risk and screening mammography: a qualitative interview study. Med Decis Making. 2001;21:231–40.PubMedCrossRefGoogle Scholar
  14. 14.
    Van Netten JP, Cann SA, Hall JG. Mammography controversies: time for informed consent? (letter) J Natl Cancer Inst. 1997;89:1164–5.PubMedGoogle Scholar
  15. 15.
    Ernster VL. Mammography screening for women aged 40 through 49—A guidelines saga and a clarion call for informed decision making. Am J Public Health. 1997;87:1103–6.PubMedCrossRefGoogle Scholar
  16. 16.
    Rimer BK. Putting the “informed” in informed consent about mammography. J Natl Cancer Inst. 1995;87:703–4.PubMedCrossRefGoogle Scholar
  17. 17.
    Gottlieb N. The age of breast cancer awareness: what is the effect of media coverage? J Natl Cancer Inst. 2001;93:1520–2.PubMedCrossRefGoogle Scholar
  18. 18.
    Anonymous. Assessing the odds. Lancet. 1997;350:1563.Google Scholar
  19. 19.
    Burke W, Olsen AH, Pinsky LE, Reynolds SE, Press NA. Misleading presentation of breast cancer in popular magazines. Eff Clin Pract. 2001;4:58–64.PubMedGoogle Scholar
  20. 20.
    Woloshin S, Schwartz LM, Byram SJ, Sox HC, Fischhoff B, Welch G. Women’s understanding of the mammography screening debate. Arch Intern Med. 2000;160:1434–40.PubMedCrossRefGoogle Scholar
  21. 21.
    Rimer BK, Halabi S, Strigo TS, Crawford Y, Lipkus IM. Confusion about mammography: prevalence and consequences. J Womens Health Gend Based Med. 1999;8:509–20.PubMedGoogle Scholar
  22. 22.
    Ransohoff DF, Harris RP. Lessons from the mammography screening controversy: can we improve the debate? Ann Intern Med. 1997;127:1029–34.PubMedGoogle Scholar
  23. 23.
    Taplin SH, Urban N, Taylor VM, Savarino J. Conflicting national recommendations and the use of screening mammography: does the physician’s recommendation matter? J Am Board Fam Pract. 1997;10:88–95.PubMedGoogle Scholar
  24. 24.
    Wells J, Marshall P, Crawley B, Dickersin K. Newspaper reporting of screening mammography. Ann Intern Med. 2001;135:1029–37.PubMedGoogle Scholar
  25. 25.
    Burman ML, Taplin SH, Herta DF, Elmore JG. Effect of false-positive mammograms on interval breast cancer screening in a health maintenance organization. Ann Intern Med. 1999;131:1–6.PubMedGoogle Scholar
  26. 26.
    Black WC, Nease RF, Tosteson AN. Perceptions of breast cancer risk and screening effectiveness in women younger than 50 years of age. J Natl Cancer Inst. 1995;87:720–31.PubMedCrossRefGoogle Scholar
  27. 27.
    Centers for Disease Control and Prevention. National Center for Health Statistics, 2002. Available at: http://www.cdc.gov/nchs/fastats/mamogram.htm. Accessed January 15, 2003.Google Scholar
  28. 28.
    Johnson JD, Meische H. Differences in evaluations of communication channels for cancer-related information. J Behav Med. 1992;15:429–45.PubMedCrossRefGoogle Scholar
  29. 29.
    Dolan NC, Lee AM, McDermott MM. Age-related differences in breast carcinoma knowledge, beliefs, and perceived risk among women visiting an academic general medicine practice. Cancer. 1997;80:413–20.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2003

Authors and Affiliations

  • Larissa Nekhlyudov
    • 1
    Email author
  • Dennis Ross-Degnan
  • Suzanne W. Fletcher
  1. 1.Department of Ambulatory Care and PreventionHarvard Medical School/Harvard Pilgrim Health CareBoston

Personalised recommendations