By Sibyl Shalo
NEW YORK, Jun 06 (Reuters Health) - Have you been paying attention to the
debate over the value of mammography screening for breast cancer in women aged
40 to 49? Does it concern you that even the experts are arguing over national
recommendations? Do you know why there is a controversy in the first place? If
your answers are yes, yes and no, you are not alone, according to a national
survey of 503 American women.
Dr. Steven Woloshin from the Department of Veterans Affairs Medical Center
in White River Junction, Vermont, and colleagues mailed a survey to a random
sample of women aged 18 and older. The questionnaire asked the women whether
they had paid attention to media reports about the debate over the benefits of
mammography screening; what they thought were the reasons for the debate; what
their reaction was to the debate; and at what age, specifically, did they think
women should begin having mammograms.
According to the survey results, published in the May 22nd issue of the
Archives of Internal Medicine, 95% of the women responded that they had been
paying some attention to the debate, and 42% said that they had paid a lot of
attention. Of these, most women said that the debate had not changed their
understanding of the issues or recommendations regarding mammography screening.
But half of the women responded that they were "upset when national expert
groups disagree about mammograms."
Despite their own perceptions that they understood the reasons for the
debate and believed that they had access to the information necessary for making
appropriate decisions about mammography screening, only 12% of the women
correctly identified scientific evidence as the source of the debate. Of these,
fewer than 1% identified the true source of the debate: the efficacy of
mammography screening in reducing breast cancer mortality rates in women aged 40
to 49.
Woloshin and his research team were troubled that nearly half (49%) of the
women erroneously thought that the controversy was about money, citing insurance
industry cost-control tactics as a major reason. More than a quarter (27%)
thought that general disagreement among professionals was the source, 15% cited
the dangers of radiation exposure, and 14% thought accuracy was the issue.
While the jury is still out regarding the age at which mammography screening
should begin, most of the women thought that a woman should have her first
mammogram before age 40. Additionally, 83% mistakenly believed that the benefits
of mammography screening for women aged 40 to 49 have been established. Very few
women were able to distinguish between the weak scientific evidence of the
benefits in this age group and the scientifically proven benefits in older
women.
"I think it's a difficult issue because especially with screening tests like
mammography and even prostate cancer screening in men, it's counterintuitive
that there would ever be a reason not to do it," Woloshin told Reuters Health in
an interview. "You'd almost be crazy not to do it, because what do you have to
lose? The question is what is the downside, that it may not work for you, that
you may get a false-positive result and need a biopsy and have all the anxiety
over that, or, be overtreated, which can also happen."
Most of the women surveyed said that their physician was their main source
of information about mammograms and 75% said that they had discussed mammography
with their physician.
Noting that the public is paying attention to the mammography debate, the
researchers conclude, "Policy makers issuing recommendations about
implementation of large-scale mammography screening services need to consider
how to effectively disseminate their message."
