Background
Mammography screening participation in differing health care systems
Methods
Setting
Participants
Interview development
Analysis
Ethics
Results
Participants characteristics
Age group (years) | Number of women | Number of women who have used mammography | Number of women who have never used mammography |
---|---|---|---|
45–50 | 11 | 6 | 5 |
51–55 | 5 | 3 | 2 |
56–60 | 6 | 4 | 2 |
61–65 | 8 | 2 | 6 |
Marital status
| |||
Widow | 3 | 2 | 1 |
Married | 26 | 13 | 13 |
Single | 1 | 1 | |
Education completed
| |||
No schooling | 1 | 1 | |
Pimary school | 21 | 8 | 13 |
Secondary school | 5 | 3 | 2 |
High school | 1 | 1 | |
Higher education | 2 | 2 | |
Work status
| |||
Retired | 4 | 1 | 3 |
Private employee | 9 | 5 | 4 |
Domestic/agricultural work | 11 | 6 | 5 |
Full time house wife | 5 | 2 | 3 |
Public office | 1 | 1 | |
Weekly household income before income tax (euro)
| |||
0–100 | 7 | 3 | 4 |
100–200 | 12 | 6 | 6 |
200–300 | 7 | 3 | 4 |
300–400 | 1 | 1 | |
400–500 | 1 | 1 | |
500–700 | 1 | 1 | |
Up 700 | 1 | 1 | |
Reported use of mammography
| |||
Never | 15 | ||
Every year | 4 | ||
Once | 6 | ||
Two – three times | 5 |
Characteristic | Number |
---|---|
Age
| |
30–35
| 4 |
36–40
| 4 |
41–45
| 3 |
46–50
| 13 |
51–55
| 2 |
56–60
| 1 |
Gender
| |
Male
| 13 |
Female
| 15 |
Specialty
| |
Internal Medicine
| 6 |
General Practitioner
| 22 |
Total years of work
| |
6–10
| 12 |
11–15
| 3 |
16–20
| 6 |
21–25
| 6 |
26–30
| 1 |
Total years of work in current position
| |
0–5
| 12 |
6–10
| 4 |
11–15
| 7 |
16–20
| 4 |
21–25
| 1 |
Mammography screening from the women's perspective
Women's knowledge of mammography
Mammography is a test you do for prevention of breast cancer. It takes place once a year, and clinical breast examination once a year. One time, as I have done, one time we do mammography and every six months clinical breast examination and observation, let's say, if something happens in this duration. (woman 21).
God has appointed doctors to save and help people and if you meet a good doctor he will do good work (woman 15)
Women's use of mammography
Barriers to mammography screening
Absence of symptoms
I've no breast problems, so mammography isn't necessary. (woman 15)We aren't the type of people who go to the doctor if we only have a pain or some health problem. If we see some trouble, we go to the doctor, but then it's a little late (laugh), a little late.(woman 4).Knock on wood, I don't know because I don't have that problem. (woman 15)We must be checked, we must be examined, but you must have some problem, eh? Without a problem should you go? No, I have never gone to a doctor about that.(woman 11)
Risk and Safety Issues
The radiation that I'll be exposed to. I also think about that because I have been having many examinations lately, but... if it is necessary. I think that we are getting radioactivity now but how harmful it is to our health I don't know. (woman 19)
I didn't ask the doctor. And since I didn't ask they haven't mentioned it. If a doctor says that I have to have a mammogram, yes, I will have it. (woman 24).It depends on what information the doctor will give to me to continue if it is necessary to do it When he says that it is must to do the mammography I will do it. If I see something to my breast and I will visit the doctor and he says to me that you must do a mammography, because the doctor says it and he knows better I will do it. (woman 13).
Fear and Negativity towards Mammography
I don't know. Sometimes as my breast is compressed, perhaps they'll crush something. (woman 18)
Because we are afraid, that maybe, let's say, you have something in your breast and you will need various other procedures and for this reason, you avoid being checked. (woman 24)
Yes I am afraid of the expected results. (woman 10)
Not a Priority
If it is something gynaecological, I may be embarrassed because here in the countryside we are, let's say, more... um... but since I've never needed to have a breast examination, a doctor to examine my breast, I don't know.(woman 7).
Nah. It's mostly the distance for me (woman 20)
Mammography screening from the physicians' perspective
Knowledge, attitudes and practices
It isn't my specialty; I can't say that I am informed. (physician 26)
I'm not well informed about whether it gives reliable information. (physician 12)
If you tell them that the mammogram is necessary, all of them have it. (physician 22)
According to the guidelines I feel that I do relatively well. As far as management of large numbers of patients, such as those who come to the office, I don't feel prepared. I don't consider myself well-informed on this subject, neither about how I will present it to the patient, nor how I will persuade her of the necessity of this examination." (physician 3)
Lack of time for adequate discussion in the clinic
When the patient visits (the clinic) at regular office hours we will almost always propose that a mammogram be done. However, when the visit occurs during the emergency shifts we often neglect it. (physician 3)
When is mammography screening recommended by physicians?
If there is a hereditary case-history then I insist more, or of course if there is a clinical finding, in the breast examination. (physician 5)The age, a possible case-history and hereditary predisposition. (physician 19)
Barriers to Mammography Screening
They have no access to mammography. The two public hospitals schedule appointments four, five or six months after referral. (physician 2)
It's a long way to the clinic for most rural women
One woman said to me: Why should I have a mammogram? It's not easy to go to Heraklion. It's too far. (physician 8).
The financial side is such a problem that many poor people would rather die than have their lives complicated every year to have a mammogram. I can't talk to them about it. In other words a lot of things stop at the Health Center. If it costs as much as the cost of a trip to Rethymnon they would rather even be diagnosed with cancer to make the trip worth it. (physician 23)
(Women say) there's nothing the matter with me, why should I have a mammography? (physician 8).
Deep down however, most of the time it is embarrassment, especially for older women. Very often it's embarrassment. (physician 6)Fear, that they will find something,...doctor, I don't want to know (physician 2).
Another high percentage considers it a painful exam from their previous experiences. (physician 3)The main reason is that they will be exposed to radiation. (physician 18)
The importance of patient's characteristics
Discussion
WOMEN | PHYSICIANS | |
---|---|---|
Absence of any symptoms |
Contextual issues
| |
Fear of radiation | Access to a mammography screening center | |
Lack of recommendation of physician | Difficulties in scheduling an appointment in state Hospitals, waiting time | |
Fear of pain | Distance, transportation problems from mountain regions to the city | |
Fear of results-diagnosis |
Women related issues
| |
Family obligations | Absence of symptoms | |
Embarrassment | Embarrassment felt by women | |
Cost | Consequences of radiation | |
Lack of information | Fear of diagnosis | |
Lack of free time | Problem of free time and family obligations | |
Distance from screening centers – Transportation problems | Cost at Private Centres | |
Physician related issues
| ||
Physician judgment and management | ||
Gender of physician |