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The aim was to investigate the influence of undergoing further examinations due to a false-positive mammogram on women's re-attendance at the next scheduled screening and their frequency of breast self-examination (BSE). Study participants included 517 women (62% response) recalled due to findings on screening mammograms indicating possible malignancies, and a matched control group of 285 women (68% response) with normal mammograms. Participants completed five and three questionnaires, respectively, during the 2 years following screening participation. While the groups did not differ significantly in screening re-attendance, women recalled due to false-positive mammograms reported significantly higher levels of anxiety related to the next screening than did women with normal mammograms. At the 1-year assessment, women with false-positive mammograms reported a significantly higher frequency of BSE than did women with normal mammograms. The present results indicate that being recalled due to a false-positive mammogram does not seem to negatively affect screening re-attendance, and may have a positive impact on BSE.

The aim was to investigate the psychological consequences of further investigation after breast cancer screening. Study participants include 509 women (61%) recalled due to suspicious findings on screening mammograms, and a matched control group of 285 women (68%) with normal mammograms. Psychological distress was prospectively assessed with the Hospital Anxiety and Depression Scale (HADS). 46% of the women reported borderline or clinically significant anxiety prior to the recall visit. A few days after the visit, anxiety and depression had decreased significantly (P<0.01) in women informed about normal or benign results at the recall clinic, while reported distress remained at relatively high levels in women referred to surgical biopsy. The results demonstrate the adverse short-term effect of a delay in receiving false-positive results, but do not indicate that the recall experience results in long-term anxiety or depression for a majority of women.

Purpose: To evaluate the effect of old mammograms on the specificity and sensitivity of radiologists in mammography screening. Material and Methods: One hundred and fifty sets of screening mammograms were examined by 3 experienced screeners twice: once without and once in comparison with older mammograms. The films came from a population-based screening done during the first half of 1994 and comprised all 35 cancers detected during screening in 1994, 12/24 interval cancers, 14/34 cancers detected in the following screening and 89 normal mammograms. Results: Without old mammograms, the screeners detected an average of 40.3 cancers (range 37-42), with a specificity of 87% (85-88%). With old mammograms, the screeners detected 37.7 cancers (range 34-42) with a specificity of 96% (94-99%). The change in detection rate was not significant. However, the increase in specificity was significant for each screener (p=0.0002-0.03). Conclusion: Mammography screening with old mammograms available for comparison decreased the false-positive recall rate. The effect on sensitivity, however, was unclear.

The aim of this study was to identify predictors of non-attendance in a population-based mammography-screening programme in central Sweden, on the basis of telephone interviews with 434 non-attendees and 515 attendees identified in a mammography register, Non-attendance was studied in relation to sociodemographic factors, indicators of general health behaviour, self-rated health and experience of cancer in others and own cancer or breast problems. Being single or being non-employed were the only important socio-demographic predictors of non-attendance. Non-attendance was more likely among women who never visited a dentist, had not visited a doctor in 5 years, had never used oral contraceptives or hormone replacement therapy, had never had cervical smear tests, never drank alcohol, smoked regularly, reported no breast cancer in family or friends or own breast problems, We conclude that socio-demographic factors alone do not appear to constitute strong predictors of non-attendance, General health behaviour and previous experience of cancer and breast disease seem to be more important factors. Our results suggest that in the setting of population-based outreach mammography programmes, previous contacts with the health care system and encouragement from health professionals represent determinants of attendance.

Background. The effectiveness of mammography screening could be improved if factors that influence nonattendance were better understood. Methods. We examined attitudes, beliefs, and knowledge in relation to nonattendance in a population-based mammography screening program, using a case-control design. Data were collected from November 1997 to March 1998 through telephone interviews with 434 nonattenders and 515 attenders identified in a population-based mammography register in central Sweden. The questions asked drew primarily upon the components constituting the Health Belief Model. Results. Multivariate analysis showed that nonattendance was most common among women within the highest quartile of perceived emotional barriers, compared to women within the lowest quartile (OR = 4.81; 95% CI 2.96-7.82). Women who worried most about breast cancer were more likely to attend than those who worried least (OR = 0.09; 95% CI 0.02-0.31). Women with the highest scores of perceived benefits were more likely to attend than women with the lowest ones (OR = 0.35; 95% CI 0.08-0.75). Other factors associated with nonattendance were less knowledge about mammography and breast cancer, lack of advice from a health professional to participate, and very poor trust in health care. Conclusions, Our findings suggest that increased participation in outreach mammography screening programs can be achieved through enhancement of breast cancer awareness and possibly by reducing some of the modifiable barriers.

The aim of this study was to compare lymph node involvement of breast cancer cases detected at mammography screening with clinically-detected cases. During a 3-year period, 273 primary breast cancers were detected in a population-based screening programme, Addresses: UNIV UPPSALA HOSP, DEPT SURG, S-75185 UPPSALA, SWEDEN. UNIV UPPSALA HOSP, DEPT CANC EPIDEMIOL, S-75185 UPPSALA, SWEDEN. UNIV UPPSALA HOSP, DEPT DIAGNOST RADIOL, S-75185 UPPSALA, SWEDEN. UNIV UPPSALA HOSP, DEPT PATHOL, S-75185 UPPSALA, SWEDEN. U