Further research should clarify determinants and consequences of depression and anxiety among real non-attenders. Knowledge gaps and attitudinal barriers among non-attenders require more targeted campaigns.
Objective-To study psychosocial predictors of attendance at an organised breast cancer screening programme. Setting-Finnish screening programme based on personal first round invitations in 1992-94, and with 90% attendance rate. Methods-Attenders (n=946) belonged to a 10% random sample (n=1680 women, age 50, response rate 64%) of the target population (n=16 886), non-attenders (n=641, 38%) came from the whole target population. Predictors were measured one month before the screening invitation. Measures included items for social and behavioural factors, Breast Cancer Susceptibility Scale, Illness Attitude Scale, Health Locus of Control Scale, Anxiety Inventory, and Depression Inventory. Univariate and multivariate logistic regression analyses were used to predict attendance. Results-Those most likely to attend were working, middle income, and averagely educated women, who had not had a mass mammogram recently, but who regularly visited gynaecologists, attended for Pap smear screening, practised breast self examination, and who did not smoke. Low confidence in their own capabilities in breast cancer prevention, overoptimism about the sensitivity of mammography, and perception of breast cancer risk as moderate were also predictive of attendance. Expectation of pain at mammography was predictive of non-attendance. Conclusion-Mammography screening organised as a public health service was well accepted. A recent mammogram, high reliance on self control of breast cancer, and an expectation of pain at mammography deterred attendance at screening. Further information about these factors and health information on screening are needed. (J Med Screen 1999;6:82-88) Keywords: mammography; attendance; psychosocial factors High quality mammographic screening of women aged 50-74 may significantly reduce breast cancer mortality.1 In Finland screening has been carried out since 1987 as a public health policy, with personal invitations sent to women aged between 50 and 59 every two years. Uptake is around 90%, 2 close to the Swedish figures 3 and higher than in many other countries with similar services.Several reports have looked at the diVerences between attenders and non-attenders. 4 Only a few studies, however, have used a prospective design in which background characteristics were monitored before the invitation to the first screening round, and participation was verified at the screening registry afterwards. Married, healthy women, interested in their health, especially health check-ups, who perceived their risk of breast cancer to be high and believed in the benefit of screening, were more likely to attend.5-7 Sociodemographic factors-for example, level of education or social class, were not predictive. 5-7Nonattendance may be partly explained by recent mammography elsewhere. It has been suggested that emotional factors, such as anxiety and depression, may aVect attendance, 9 but no study has included standardised, prospective measures.This study aimed at determining the influence of psychosocial factors, cognitiv...
This prospective study examined whether the psychological impact of organized mammography screening is influenced by women's pre-existing experience with breast cancer and perceived susceptibility (PS) to the disease. From a target population of 16,886, a random sample of women with a normal screening finding and all women with a false positive or a benign biopsy finding were included (N=1942). Data were collected with postal questionnaires 1-month before screening invitation and 2 and 12 months after screening. Response rate was 63% at baseline; 86, and 80% of the baseline participants responded to the follow-ups. Psychological impact was measured as anxiety (STAI-S), depression (BDI), health-related concerns (IAS), and breast cancer-specific beliefs and concerns. Data was analyzed with repeated measures analyses of variance, with estimates of effect size based on Eta-squared. Women with breast cancer experience had higher risk perception already before screening invitation; after screening they were also more distressed. Women with high PS were more distressed than women with low PS also at pre-invitation. The distress was not alleviated by screening, but instead remained even after normal mammograms. Experience and PS did not influence responses to different screening findings. Of the finding groups, false positives experienced most adverse effects: their risk perception increased and they reported most post-screening breast cancer-specific concerns. Furthermore, they became more frequent in breast self-examination (BSE) despite a simultaneous decrease in BSE self-efficacy. Our findings suggest that women with high PS and women with false positive screening finding may need individualized counseling and follow-up as much as women with a family history of breast cancer. Besides medical risk factors, women's own perceptions of susceptibility should be discussed during the screening process.
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