Mammography Adherence: A Qualitative Study (Watson-Johnson et al., 2011).
Mammography is a procedure that entails using radiation for early detection of breast cancer in women to facilitate proper management after diagnosis. Despite its proven efficacy in reducing breast cancer-related deaths and a pronounced increase in its use among women between 1987 and 2000, a sharp decline has been noticed in adherence to its continued use. Watson-John et al. in this study aims at uncovering the cause of this sharp decline in usage of mammography by various categories of women who have used it in the past.
In designing the methodology for this research, focus group segmentation was chosen after consultation with experts and the review of existing literature. Women within the age range 43-75 years were drawn from various ethnic groups to participate in the focus groups. These women are those that have had mammography screening in the past two years from the time of the study. The racial/ethnic groups considered in this study included white non-Hispanic (WNH), black non-Hispanic (BNH), Hispanic, Japanese American ( JA), and American Indian/Alaska Native (AI/AN). Further segmentation of the focus groups was also done by age groups and insurance status.
Data was obtained from the participants through a pre-discussion information sheet and also through oral interview by professional female moderators. A software program for qualitative data analysis, “Atlas.ti” was used to analyze the data collected.
The analysis of the collected data resulted in the identification of five major impediments to the continuation of routine screening by formally adherent women. The first of these categories included participants that did not have faith in the effectiveness of the mammogram as a result of what was termed “false positive” and “false negative” results. The false positive result is that which showed a presence of cancer whereas there is no cancer present while the false negative result showed a cancer-free result only for the subject to be diagnosed with breast cancer shortly afterwards. Some participants further stated that there is a higher likelihood that a woman will detect a cancer herself than a mammogram. The second category comprised of the participants that had concerns about the mammography procedure. Their complaints included lack of sensitivity and dignity on the part of the technicians conducting the test, embarrassment and even fear of developing cancer from frequent exposure to the radiation from the mammography procedure. In the third category were participants who considered access to mammography as hindrance to adherence to the routine tests. These restrictive factors included insurance, cost, long wait times for appointments and inconvenient location of the test facility. The obstacles identified by the fourth category of participants are “psychosocial issues”. Some participants held the belief that a formally healthy person can develop cancer just by worrying and thinking about it. They will thus prefer not to go for the screening. Some believed they were not prone to contracting cancer due to the “healthy lifestyle” they live while some are afraid of being diagnosed with breast cancer. The fifth category identified “cultural factors” as the reasons that prevent them from having a mammography screening. The belief by the Japanese women that their ethnic group is not prone to breast cancer and a cultural taboo that prohibits an AI/AN woman exposing her breasts to strangers contributed to the excuses in this category.
After noticing the decline in the adherence rate, the United States Preventive Services Task Force (USPSTF) and other stakeholders in the use of mammography have maintained that mammography still remains the best means for early detection of breast cancer and must be used consistently for efficacy. They however suggested steps that must be taken by each of the stakeholders involved to overcome the obstacles that have been identified and make screening appealing to women.
One of such intervention is embarking on enlightenment campaigns to intimate women of the risks and benefits involved in mammography screening. While noting that mammography screening has reduced breast cancer prevalence by 50%, it should also be acknowledged that up to 20% of breast cancer does not get detected by mammography screening. This information should be made available to patients. This step will address the concerns raised by the first and second groups of participants about the ineffectiveness of mammography and about the mammography procedure respectively. Furthermore, a healthy positive relation between mammography providers and patients has been identified to promote adherence to breast cancer screening. Achieving this also entails giving health information to each of the women as it pertains to her.
In addressing the fear of the procedure as expressed by the participants, educating women and providing them with peer support groups was suggested. The structural barriers can be addressed by favorable policies as The Affordable Care Act of 2003 is expected to address issues of cost.
This research work on determining the causes of non-adherence to mammography screening has provided new insights for radiology technology. The major issues as pertaining to radiology technology that came up in this research were the perceived inefficacy of mammography, inhumane treatment of patients by radiology technicians and risk of disease from exposure to radiation. Although mammography still remains the best means of breast cancer prevention, I think all these issues need to be addressed for a wider acceptance of any radiation technology.
Being the only qualitative research conducted after a decline in mammography adherence was observed, it has offered a whole new perspective to understanding the causes of this trend. I think however that examining the effects of the recommendations by the USPSTF will help strengthen the arguments of this research work. Furthermore, a larger number of participants, also including more ethnic groups should be involved in the study because the larger a sample size, the easier it is to generalize findings.
Watson-Johnson, L.C., DeGroff, A., Steele, B., Revels, M., Smith, J.L., Justen, E., Richardson, L.C. (2011). Mammography Adherence: A Qualitative Study. Journal of Women's Health, 20(12), 1887 - 1894. doi:10.1089/jwh.2010.2724.