ST. LOUIS, Jan. 5, 1998 -- About half of U.S. deaths from breast cancer each year occur in women who are 65 years of age or older. Yet older women, especially minorities, get the fewest mammograms. A new study at Washington University School of Medicine in St. Louis suggests that doctors may help turn this trend around by addressing women's fears of finding a lump and other barriers to being tested.
"Telling women they should get mammograms isn't enough," says Celette Sugg Skinner, Ph.D., assistant professor of radiology at the School of Medicine's Mallinckrodt Institute of Radiology. "It's important to first find out what a woman's thinking. If she's not leaning toward getting a mammogram, the first step should be to find out why."
Skinner was primary investigator in a study of 253 women living in two high-rise complexes in urban St. Louis. A 1995 phone survey of these women, who were 65 years of age or older, explored the erroneous beliefs, fears and practical issues that deter women from getting mammograms. The findings are published in the January issue of the American Journal of Preventive Medicine.

About half the women had received a mammogram within the past two years. About a third were not thinking of being tested, and the remaining 16 percent were contemplating the screening test.

Overall findings revealed that women were more likely to have had recent mammograms if they were younger than 75, were more educated, were nonsmokers or received fairly regular medical care.

The survey also showed that many women shared certain misconceptions about breast cancer and mammography. For example, many mistakenly believed that self-exams can find lumps as small as the pea-sized ones revealed by mammograms.

However, women who were not even considering getting mammograms were somewhat more likely to believe that:

• breast cancer is a young woman's disease

• finding a cancerous lump would likely lead to a mastectomy

• a woman who protects her breasts from being bumped, bruised or fondled is less likely to get breast cancer

Fear of finding a cancerous lump was the major barrier for those already considering getting tested. Skinner says these women may need more information on mammography's benefits and a reassuring reminder that most breast lumps are not cancerous.

Those held back mainly by erroneous beliefs may decide to get exams if given proper information about their risk of breast cancer and benefits of early screening, she notes. Although having a doctor or nurse suggest a mammogram helped, the survey revealed that this advice alone did not spur women to get exams.

Surprisingly, women who received care at private doctors' offices also were among those less likely to have had mammograms. Skinner speculates that breast cancer may not be discussed as often if older women visit a private physician for specific health-care needs. And health-care clinics may be closer to mammography sites or be able to arrange transportation. Cost was not found to be a significant concern, and should become even less of a factor as Medicare begins covering annual mammograms this year.

The study also found that fear of pain during a mammogram was an issue for some women. During the exam, a woman's breast is pressed between two plates to get a good X-ray image of breast tissue. This pressure often causes a feeling of tightness and may cause discomfort. Skinner notes that any uneasiness will be short-lived, however. "A mammogram takes only a few seconds, and it can reveal breast cancer before it becomes a serious disease," she says.