Most women would accept more mammograms

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Despite the inconvenience and anxiety of being recalled for a repeat mammogram after a questionable finding, most women would willingly undergo additional tests if this would result in even a slightly increased chance of earlier breast cancer detection, a new survey shows.

“Overall, we found that women who responded overwhelmingly preferred this trade-off,” Dr. David Gur and his colleagues report.

Guidelines urge radiologists to keep their recall rates at or below 10 percent in order to reduce costs and prevent unnecessary anxiety among women undergoing the screening test, the researchers note, but there has been very little research on what the preferences of the women themselves might be.

"Given the fact that mammography is not a perfect procedure and is not likely to become one, the need to involve women in the decision-making process concerning their own health may be obvious to some yet is frequently not met,” write Gur, at the University of Pittsburgh Medical Center, and colleagues in their report in the journal Radiology.

To find out women’s preferences regarding the recall rate after mammography, the researchers surveyed 1,528 women who underwent routine screening mammography at three Pennsylvania clinics between November 2004 and 2005.

Along with general questions about mammography, women were asked if they would take the chance of being called back for another mammogram, if this meant that if they had cancer it would be detected earlier. Women were also asked the same question with regard to an invasive test, such as a surgical biopsy.

To put the issue in perspective, the questionnaire stated that a 15 percent recall rate, as opposed to 10 percent, “might increase the chance (for example, 1 out of 200 instead of 1 out of 300) that if I have cancer it might be detected earlier.”

For a non-invasive test, 86 percent of the women said they would prefer to be recalled more often; for an invasive procedure, the acceptance rate was 82 percent.

Preferences were similar among women who had come for their first mammography and those who had had the procedure several times. Women with a family history of breast cancer and those who had no such history showed the same preferences. And women who had already been recalled at least once after a screening mammogram were more likely to accept a higher recall rate in exchange for earlier cancer detection.

The researchers conclude: “We believe that a large fraction of women who actively participate in screening mammography would prefer a higher recall rate if it resulted in even a small increase in the probability of earlier cancer detection.”

SOURCE: Radiology, March 2006.

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