Mammography screening: views from women and primary care physicians in Crete

Abstract

BackgroundBreast cancer is the most commonly diagnosed cancer among women and a leading cause of death from cancer in women in Europe. Although breast cancer incidence is on the rise worldwide, breast cancer mortality over the past 25 years has been stable or decreasing in some countries and a fall in breast cancer mortality rates in most European countries in the 1990s was reported by several studies, in contrast, in Greece have not reported these favourable trends. In Greece, the age-standardised incidence and mortality rate for breast cancer per 100.000 in 2006 was 81,8 and 21,7 and although it is lower than most other countries in Europe, the fall in breast cancer mortality that observed has not been as great as in other European countries. There is no national strategy for screening in this country. This study reports on the use of mammography among middle-aged women in rural Crete and investigates barriers to mammography screening encountered by women and their primary care physicians.MethodsDesign: Semi-structured individual interviews. Setting and participants: Thirty women between 45–65 years of age, with a mean age of 54,6 years, and standard deviation 6,8 from rural areas of Crete and 28 qualified primary care physicians, with a mean age of 44,7 years and standard deviation 7,0 serving this rural population. Main outcome measure: Qualitative thematic analysis.ResultsMost women identified several reasons for not using mammography. These included poor knowledge of the benefits and indications for mammography screening, fear of pain during the procedure, fear of a serious diagnosis, embarrassment, stress while anticipating the results, cost and lack of physician recommendation. Physicians identified difficulties in scheduling an appointment as one reason women did not use mammography and both women and physicians identified distance from the screening site, transportation problems and the absence of symptoms as reasons for non-use.ConclusionWomen are inhibited from participating in mammography screening in rural Crete. The provision of more accessible screening services may improve this. However physician recommendation is important in overcoming women's inhibitions. Primary care physicians serving rural areas need to be aware of barriers preventing women from attending mammography screening and provide women with information and advice in a sensitive way so women can make informed decisions regarding breast caner screening.

Factors that influence mammography screening behaviour: A qualitative study of Greek women's experiences

“…Breast cancer experiences that arose from some interviewees' immediate networks created the emotion of fear towards breast cancer, which acted either as a motivation or as a barrier to mammography screening. Such a consistent association between high perceived risk of developing breast cancer in the future and experiences arising from women's immediate social networks was also identified in a variety of other research studies (Katapodi et al 2004;Trigoni et al 2008;Tejeda et al 2009). Thus, our findings add further insight to the TPB by emphasizing the different effect significant others may have, depending on the quality of interactions with them.…”

“…Poor interactions with physicians and the mammography screening procedure itself (such as painful mammograms and discomfort) were identified through a review on the benefits and harms associated with screening (Meissner et al 2004), as well as in other studies (Dilhuydy et al 1997;Nekhlyudov et al 2003). Anxiety, fear of breast cancer diagnosis (Trigoni et al 2008), and lowlevel of risk perceptions and worry (Nekhlyudov et al 2003) were also found as barriers to participation in mammography screening. Lack of information relating to breast cancer and its early detection (Borgias et al 1998;Giakimoba et al 2003), as well as the long distance from the screening centre (Simou et al 2010) contributed to non-participation in mammography screening.…”

“…Broadcast media were viewed as an important source of information regarding the benefits of breast screening on reducing risks from breast cancer, having an important role in motivating women to undergo mammography screening (Nekhlyudov et al 2003). Others, however, identified personal communication with health care providers and other women to be of greater importance (Clover et al 1996;McCaul et al 1999;Trigoni et al 2008). High socio-economic status was further identified to facilitate women in mammography screening participation (Meissner et al 2004).…”

“…Only a few academic studies (Borgias et al 1998;Giakimoba et al 2003;Trigoni et al 2008;Simou et al 2010) have investigated the factors that influence Greek women to participate in mammography screening. Contrary to the variety of studies carried out in other countries in the same field, the subject has only been superficially explored in Greece.…”

Perception of Breast Cancer Screening among Iranian Women without Experience of Mammography: A Qualitative Study

“…Also, other study shown that women had a greater tendency for female doctors at a screening clinic than male doctors (Yanikkerem, 2009). It shows that cultural information is essential in order to avoid shame for women whose culture contains the meaning of modesty and privacy (Watts, 2004). The negative impact of this finding may be more intense among Iranian women due to the fact that Islamic practice requires women to completely cover their bodies and wear a veil.…”