Should anxiety inform screening?

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Lisa Fratt, Editor

For a quarter of a century, October has been designated as National Breast Cancer Awareness month. The last 25 years have been marked by incredible progress, including a 30 percent reduction in the breast cancer death rate since 1990, the introduction of digital mammography and the availability of more personalized treatment options.

Despite the progress, much work remains. Mammography is not a foolproof screening mechanism (though few tests are) and integration among multi-modality breast imaging systems remains a work-in-progress.

However, attitudes and misconceptions also play a significant role in shaping access to screening.

California Gov. Edmund G. Brown Jr. vetoed SB 791, a bill would have required mammography providers to notify women about their breast density and potential benefits of additional screening such as ultrasound and MRI. In his veto, Brown cited the potential "anxiety" that such information might provoke.

Others, most notably the U.S. Preventative Services Task Force (USPSTF), also have relied on this argument. In 2009, USPSTF referred to the potential for patient anxiety after a false-positive mammogram to justify its decision to revise its screening mammography recommendations and suggest that women ages 40 to 49 discuss screening with their physicians, rather than recommending mammography for this cohort.

However, data demonstrate that this is a false argument. A nationwide survey, commissioned by Are You Dense, showed that more than half of women experienced anxiety while waiting for the results of their mammogram, but 80 percent do not let anxiety dissuade them from screening. In fact, nine out of 10 women who required a biopsy to determine a false positive indicated that they would still opt for additional screening the following year.

Similarly, nearly nine in 10 women reported that having a regular mammogram gave them a feeling of control over their own healthcare and nearly 90 percent of women who had a mammogram considered the exam important to their health and well-being, according to a recent poll of 1,000 American voters conducted for the American College of Radiology.

We do need data to support screening recommendations. However, referring to anxiety as a reason to limit access to screening or health information is unacceptable and paternalistic. It’s time to make decisions based on science, not perceived emotions.

How is your organization educating women about breast screening options? Let us know.

Lisa Fratt, editor