Mammographic screening of women with increased risk of breast cancer

Numerous studies have demonstrated that the use of screening mammography improves the prognosis of breast cancer, and that more widespread use of mammographic screening would not only save many lives but would also permit greater numbers of women to be treated with breast-conserving therapy. Nevertheless, the majority of women of appropriate age have not adopted routine mammography into their health care programs, and physicians do not widely recommend mammography to their patients. Clearly, any understanding of the behavioral impediments to routine mammography may have large payoffs in terms of public health. Indeed, in an era of otherwise skyrocketing costs of medical care, the benefits which may be achieved through mammographic screening are quite cost-effective. In an effort to evaluate the reasons for seeking or not seeking mammography, researchers studied 1,002 women. These women consisted of 501 subjects who were at high risk for breast cancer, most often because one or more first-degree relatives had breast cancer, and 501 matched controls. Although it might be expected that women at increased risk would take greater advantage of opportunities for early diagnosis, this was not the case. This failure to obtain mammographic screening was not due to a failure to perceive the increased risk. Seventy-nine percent of the high-risk women perceived themselves as high-risk, in contrast to 54 percent of the controls. Nevertheless, there was no statistically significant difference between the groups regarding the number of mammograms received. Curiously, among the women in either group who had not had a mammogram, the lack of a physician's order to do so was given as a major reason, but among the women who did have a mammogram, a physician's order was less important and major reasons given for deciding on mammography included media publicity. The results indicate that members of families with a high incidence of breast cancer should continue to be sought out and encouraged to participate in regular breast cancer screening programs. (Consumer Summary produced by Reliance Medical Information, Inc.)