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Why Women Don’t Return for Mammography Follow-up

Why Women Don’t Return for Mammography Follow-up

WASHINGTON—Young women who are depressed, think of themselves as being at
low risk for breast cancer, or have relatively painless mammograms are likely
to skip diagnostic follow-up, according to Alexis Bakos, PhD, MSN, RN,C. In a
podium presentation at the Oncology Nursing Society’s 27th Annual Congress
(abstract 10), Dr. Bakos said that 25% to 60% of women do not return for
follow-up and that the goal of her study was to determine who does not
return, and why.

"The question we addressed was why a woman would engage in a health
promoting procedure such as screening mammography but not return for
diagnostic follow-up," said Dr. Bakos, a cancer prevention fellow at the
National Cancer Institute, Bethesda, Maryland.

Dr. Bakos invited 243 patients from a convenience sample at two urban
university medical centers to participate in the study. She reported data
from the 75 women who agreed: 44 who had returned for diagnostic follow-up
and 31 who had not. This was a relatively poor, urban population: 45% had
less than a 12th grade education, 46% had household income less than $10,000
a year, 52% were unemployed, and 89% were black. Most (62%) had insurance
coverage for their mammograms. Ages ranged from 29 to 85 years (mean, 52
years).

Study investigators interviewed all 75 women by telephone. They used Cox’s
Interaction Model of Client Health Behavior to identify characteristics
associated with returning for follow-up vs not returning, and reasons for
returning vs not returning.

The interview questions covered social influences, previous health care
experience, environmental resources, cancer fatalism (measured by the Powe
Fatalism Inventory), anxiety (measured by the Trait Anxiety Inventory),
depression (measured by the Beck Depression Inventory), perceived cancer
screening experience, and mammography-induced pain (measured by the
Painometer-Words scale).

Dr. Bakos had expected that youth (50 years old or younger), depression,
and an assumption of low-risk would correlate with not returning, and
multivariate analysis showed that this was the case. But women with cancer
fatalism and those who had a less painful mammogram also had significantly
greater odds of not returning for follow-up.

"We were surprised that women who experienced more pain during mammography
were actually more likely to return for follow-up," Dr. Bakos said. "Data
from the qualitative arm of the study showed that many of these women thought
that ‘everyone knows’ that cancer is painful, so if the mammogram was not
painful, whatever was there must not be cancer."

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