Mammography screening: Patient information leaflets do not affect willingness to participate

In Germany, the invitation to undergo mammography screening that is sent to all women between the ages of 50 and 69 is accompanied by an information leaflet explaining the advantages and disadvantages of screening. In this issue of Deutsches Ärzteblatt International (Dtsch Arztbl Int 2015; 112: 61-8), Elisabeth Gummersbach and colleagues report on a study in which they determined how well the prospective subjects understood the information presented and whether this information influenced their willingness to undergo screening. It was found that the leaflet itself made little or no difference to the women’s willingness to participate. Rather, the most important factor in the decision whether to be screened was usually a doctor’s personal recommendation.

From 2010 onward, mammography for the early detection of breast cancer has been recommended for all women in Germany aged 50 to 69. Screening nonetheless remains controversial. While it is true that women who undergo screening are less likely to die of breast cancer, they may also receive erroneous diagnoses and unnecessary treatments.

Out of 1000 women who undergo mammography screening regularly for 10 years, 1 to 3 will survive who would otherwise have died of breast cancer, but 100 to 300 will have a false positive mammography finding that can cause considerable emotional distress.

As many as 5 of these women may actually undergo unnecessary treatment for cancer. As the authors point out, the leaflets apparently had little or no effect on the women’s decisions to undergo screening or not: only 3.6% said it played a role in their decision, while nearly 50% said their doctor’s recommendation was a major factor.

These findings imply that a leaflet alone does not enable women to make a well-informed decision about mammography screening, as required by current German law. The authors recommend that women who are candidates for mammography should have a personal discussion with an appropriate professional about this subject, in addition to being given suitable written information.

Mammogram facts

  Mammograms are images of the breast tissue produced on X-ray film.
  Mammograms are the most efficient screening method to detect early breast cancer.
  Monthly breast self-examination and regular doctor’s examinations are combined with mammography for optimal breast cancer screening.
  An abnormal mammogram does not necessarily mean that a cancer is present, Other tests, including biopsy, may be performed for further clarification of an abnormal mammogram.
  A normal mammogram does not exclude the presence of cancer.


What is a mammogram?

Mammography screening: Patient information leaflets do not affect willingness to participate A mammogram is an X-ray test that produces an image of the inner breast tissue on film. This technique, called mammography, is used to visualize normal and abnormal structures within the breasts. Mammography, therefore, can help in identifying cysts, calcifications, and tumors within the breast. It is currently the most efficient screening method to detect early breast cancer. Breast self-examination (BSE) on a monthly basis and examination by a doctor are still important, but physical examinations typically find breast cancers when they are much larger than those detected by mammography.

Mammography can be used to discover a small cancer in a curable stage; however, it is not foolproof. Depending a woman’s age and other factors, approximately ten to fifteen percent of breast cancers are not identified by mammography, and these cancers are often found by physical examination. It is essential for a woman to perform monthly BSE and have a breast examination by her doctor in addition to the mammogram in order to most effectively screen for breast cancer.

The American Cancer Society recommends that a woman obtain her first baseline mammogram at the age of 40. After that, she should receive a yearly mammogram. Women who are at high risk for developing breast cancer may need to obtain mammograms earlier than these recommendations and at more frequent intervals. Medicare, Medicaid, and most private insurance companies generally cover the cost of mammography.

Elisabeth Gummersbach
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Deutsches Aerzteblatt International

  Deutsches Ärzteblatt International

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