“Urgent research” is needed to establish why over 40 per cent of women invited for breast screening do not take up the offer, a study has urged.
Published in the Malta Medical Journal, the study focuses on women’s satisfaction with the Maltese breast screening programme.
Since participation was found to be 55.9 per cent, the authors stressed that “urgent research to investigate local reasons for non-attendance is vital in order to increase the screening compliance rate in Malta as recommended by European screening guidelines”.
Breast screening in Malta is available for women between 50 and 65 years of age. Every woman in that age bracket is invited for screening at three-year intervals.
Women’s understanding of the potential benefits has shown to be imperfect in this study
In general, the results show a high satisfaction rate among women who attended the breast screening programme, with clients praising the pleasant and clean environment as well as the staff. The majority felt that the examination was not lengthy and that they had enough privacy.
However, nearly 30 per cent faced difficulties in getting to the breast screening unit in Lascaris Wharf, Valletta, due to limited parking and no bus access.
There is solid evidence that women who face difficulties getting to the screening unit are less satisfied with the screening programme, notes the study, conducted by Danika Marmarà, Judi Curtis and Vincent Marmarà.
Strategies to reduce logistical barriers are required, including external signage to enhance accessibility to the centre, the study recommended.
The majority of the clients rated the mammogram as “slightly uncomfortable”. However, 22 per cent reported the examination as “severely uncomfortable” and were more likely not to re-attend.
Strategies to minimise pain and discomfort were required if high levels of satisfaction and attendance were to be maintained, the study noted.
Previous studies indicated that experiences of pain, discomfort and distress were associated with dissatis-faction, and they undermined women’s decisions to undergo repeat screening. Moreover, a woman’s satisfaction with her own mammography experience may also affect whether relatives or friends undergo mammography or attend a particular mammography unit.
Overall, clients experienced a wide range of emotions prior to mammography.
A high percentage of women experienced anxiety, with 75 per cent of clients stating that their main anxiety was due to “fear of the result” and “its impact on the individual and their family”.
Nearly 70 per cent of women said they would have refused to undergo mammography if the radiographer were a male.
There is a wide variability of recall rates between countries, ranging from less than one per cent to about 15 per cent for screening mammography. European guidelines recommend a target recall rate of five per cent. The study found that 17.1 per cent were recalled for further tests, which is higher than the number recommended by European guidelines.
Women recalled for further assessment had a higher incidence of anxiety, as they tend to react as though they have already been diagnosed with cancer, the study explained.
“Hence, our results substantiate the constant need for effective communication and psychological support throughout the screening process.”
Although information (such as leaflets) is provided to women attending the programme, they may need to be better informed about the consequences of screening and the possibility that a biopsy procedure may in turn lead to extensive surgery.
“Women’s understanding of the potential benefits, harms and shortcomings of breast screening, including overdiagnosis and overtreatment, has shown to be imperfect in this study […] thus requiring better informed consent to guide screening decision-making.”