Mammography screening - motivational factors and obstacles among women in primary care

Krisztián Vörös, Bernadett Márkus, Zoltán Lakó-Futó, Csenge Hargittay, Peter Torzsa

Keywords: breast cancer, screening, mammography, motives, obstacles

Background:

The relatively low attendance rates to mammography screening dropped significantly since the COVID pandemic.

Research questions:

Our aim was to investigate motives and obstacles to screening among women in primary care to identify possibilities to improve attendance rate.

Method:

In two teaching practices, women aged 40-65 years were asked in email to fill out a self-administered questionnaire about lifestyle, risk factors, motivational factors and experienced obstacles to mammography. Last screening dates were obtained from the electronic medical records.

Results:

There were 1092 women in this age group, 429 had an email address available. The response rate was 37.8% (162). The mean age of respondents was 52.6 ± 6.9 years (mean ± SD). Attendance to mammography within two years was 52.8%.
The presence of lifestyle risk factors was low: smoking (15.3%), alcohol consumption (11.0%), while anticoncipient use was common (66.3%). In postmenopausal women overweight was present in 34.4%, obesity in 13.5%. Breastfeeding beyond 12 months cumulatively, was rare (10.4%), but 74.2% gave birth before the age of 35. Positive family history affected 25.8% of patients.
The highest ranked three motives for attendance were being aware of the advantages of screening; caring about a healthy and lasting life and being important to oneself.
The three most mentioned obstacles to screening were having difficulties booking an appointment; fear of treatment and long waiting time.
Attendance to screening was associated with being important to oneself, while not having a mammography within two years correlated with fear of cancer and mammography, time pressure, appointment scheduling difficulties, feeling healthy, having financial difficulties about the test and not caring enough about one's health.

Conclusions:

A large number of patients have risk factors for breast cancer in primary care without attending to mammography. A lot of obstacles are health-system related, however by knowing motives and obstacles GPs could help patients overcome these difficulties.

Points for discussion:

Balance of harms and benefits for certain risk status and age groups

Improving attendance to mammography

The role of GPs to motivate and help patients overcome obstacles