Do Older Women Trust Mammography Too Well?


ORLANDO — Older women with a family history of breast cancer place extraordinary faith in mammography over clinical breast exam for reassurance about their breast health, according to Karen Greco, R.N., Ph.D., lead investigator of a small, qualitative study on mammography decision making in this population.

Furthermore, many of these women may not appreciate their potentially increased risk for hereditary cancer syndromes, added Dr. Greco, who presented her study as a poster at the annual meeting of the Gerontological Society of America.

“The women in my study were not aware that if they had a first-degree relative with breast cancer and another one with ovarian cancer, that there was a connection,” she said in an interview. “Although some had been asked about family history they didn't understand what it meant, and they didn't understand the significance.”

Ten of the 16 women in her study had family histories that suggested they could be at risk for a hereditary cancer syndrome, yet they reported they had not received a cancer risk assessment, said Dr. Greco of the Oregon Health & Science University School of Nursing in West Linn.

The study included 16 women over age 65 years (average age 73) who were at increased risk for breast cancer because of both family history—defined as at least one first-degree relative diagnosed with breast cancer—and advancing age.

Open-ended, semistructured interviews were conducted with the women to explore their decisions about screening mammography.

Although 15 of the 16 women had regular visits with their health care provider, and 14 had regular mammograms, less than half (7) said they received regular clinical breast exams, Dr. Greco said.

“Many said they believed very strongly that mammography is more effective than clinical breast exam or self-[administered] breast exam because 'mammograms can see inside me',” she said.

“There was extraordinary confidence in mammography to the point that if women heard negative information about the effectiveness of mammograms, they ignored it,” Dr. Greco added

In addition, many women entertained the mistaken belief that their risk for breast cancer decreased with age, she said.

“We may need to look more at what older women's beliefs are about cancer risk and age because they don't all believe that increased age increases their risk,” she said.

The study highlights the emotional consequences of mammography in high-risk women, Dr. Greco noted.

Women described their worry if they were asked to return because of an abnormal finding, and they described decreased worry if they were given their results immediately.

“It may be helpful for physicians to know that for high-risk women, having mammograms is an emotional experience, and we may need to look at providing them with some emotional support,” she said.

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