Women's views on breast cancer risk and screening mammography: A qualitative interview study

Background. To promote informed decision making about mammography, clinicia ns are urged to present women with complete, relevant information about bre ast cancer and screening. Understanding women's current beliefs may help gu ide such efforts by uncovering misunderstandings, conceptual gaps, and area s of concern. Objective. The authors sought to learn how women view breast cancer, their personal risk of breast cancer, and how screening mammography affects that risk. Methods. Forty-one open-ended semistructured telephone interviews with women selected from a national database by quota sampling t o ensure a wide range In demographics of the participants. Results. Almost all respondents viewed breast cancer as a uniformly progressive disease tha t begins in a silent curable form (typically found by mammograms) and, unle ss treated early, invariably grows, spreads, and kills. Some women felt tha t any abnormality found must be treated, even if it was not malignant. None had heard of potentially nonprogressive cancers, and when informed, most f elt that the uncertain prognosis of such lesions reinforced the need to fin d and treat disease as soon as possible. Women expressed a wide range of vi ews about their personal risk of breast cancer. Although some saw breast ca ncer as a central threat to their health, many others cited heart disease, other cancers, violence, and trauma as greater concerns. Most recognized th e importance of "uncontrollable" factors for breast cancer such as age, sex , family history, and genetics. However, other "controllable" factors with little or no demonstrated link to breast cancer (e.g., smoking, diet, toxic exposures, "bad attitudes") were given equal or greater prominence, sugges ting that many women feel considerable personal responsibility for their le vel of breast cancer risk. Similarly, although women recognized that mammog raphy was not perfect, almost all believed that failure to have mammograms put one at risk for premature and preventable death. When asked how mammogr aphy worked, almost all repeated the message that "early detection saves li ves," suggesting that advanced cancer (and perhaps most cancer deaths) refl ected a failure of early detection. The belief in the benefit of early dete ction was so strong that some women advocated scaring other women into gett ing mammograms because it is "better to be safe than sorry." Conclusions. W omen view breast cancer as a uniformly progressive disease rarely curable u nless caught early. The exaggerated importance many attribute to a variety of controllable factors in modifying personal risk and the "danger" seen in failing to have mammograms may lead women diagnosed with breast cancer to blame themselves.