Articles
15 April 1991

Psychological and Behavioral Implications of Abnormal Mammograms

Publication: Annals of Internal Medicine
Volume 114, Number 8

Abstract

Objective: To evaluate women's psychological responses to abnormal mammograms and the effect on mammography adherence. To identify psychological responses and other factors that predict mammography adherence in women with normal or abnormal mammograms.
Design: Survey study with prospective analysis of factors associated with mammography adherence.
Setting: Health Maintenance Organization of Pennsylvania and New Jersey (HMO PA/NJ).
Patients: Study patients, members of HMO PA/NJ who were 50 years of age or older, and who had had mammography done 3 months earlier, included women with normal mammograms (n = 121), women with low-suspicion mammograms (n = 119), and women with high-suspicion mammograms (n = 68), but not women with breast cancer.
Measurements: Psychological responses 3 months after mammography and adherence to subsequent annual mammography were assessed.
Main Results: Women with high-suspicion mammograms had substantial mammography-related anxiety (47%) and worries about breast cancer (41%). Such worries affected the moods (26%) and daily functioning (17%) of these women, despite diagnostic evaluation excluding malignancy. For each variable, a consistent trend (P > 0.05) was seen with degree of mammogram abnormality. Sixty-eight percent of women with normal results, 78% of women with low-suspicion results, and 74% of women with high-suspicion results obtained their subsequent annual mammograms (P > 0.05). The number of previous mammograms (odds ratio, 3.2; 95% CI, 1.6 to 6.2) and the effect of the previous results on concerns about breast cancer (odds ratio, 0.5; CI, 0.2 to 1.0) were independent predictors of adherence in logistic regression analyses (P < 0.05).
Conclusions: A substantial proportion of women with suspicious mammograms have psychological difficulties, even after learning that they do not have cancer. Such sequelae do not appear to interfere with subsequent adherence.

Get full access to this article

View all available purchase options and get full access to this article.

References

1.
Lerman CRimer BTrock BBalshem A, and Engstrom P. Factors associated with repeat adherence to breast cancer screening. Prev Med. 1990;19:279-90.
2.
Rimer BKeintz MKessler HEngstrom P, and Rosan J. Why women resist screening mammography: patient-related barriers. Radiology. 1989;172:243-6.
3.
Winchester DLasky HSylvester J, and Maher M. A television-promoted mammography screening pilot project in the Chicago metropolitan area. CA. 1988;38:291-309.
4.
Dawson D and Thompson G. Breast Cancer Risk Factors and Screening: United States, 1987. Hyattsville, Maryland: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control, National Center for Health Statistics; 1990 DHHS publication (PHS) no. 90-1500.
5.
Baker L. Breast Cancer Detection Demonstration Project: Five-year Summary Report. New York: American Cancer Society, Inc.; 1982.
6.
Eddy DHasselblad VMcGivney W, and Hendee W. The value of mammography screening in women under age 50 years. JAMA. 1988;259:1512-9.
7.
Moskowitz M. Costs of screening for breast cancer. Radiol Clin North Am. 1987;25:1031-7.
8.
Macdonald LSackett DHaynes R, and Taylor D. Labelling in hypertension: a review of the behavioural and psychological consequences. J Chronic Dis. 1984;37:933-42.
9.
Reelick Nde Haes W, and Schuurman J. Psychological side-effects of the mass screening on cervical cancer. Soc Sci Med. 1984;18:1089-93.
10.
Alagna SMorokoff PBevett J, and Reddy D. Performance of breast self-examination by women at high risk for breast cancer. Women Health. 1987;12:29-46.
11.
Greenwald HBecker S, and Nevitt M. Delay and noncompliance in cancer detection: a behavioral perspective for health planners. Mil-bank Mem Fund Q Health Soc. 1978;56:212-30.
12.
Lerman CTrock BRimer BJepson CBoyce A, and Brody D. Psychological side-effects of breast cancer screening. Health Psychol. 1991 [In press].
13.
Lerman CRimer B, and Engstrom P. Reducing avoidable cancer mortality through prevention and early detection regimens. Cancer Res. 1989;49:4955-62.
14.
Dupont W and Page D. Risk factors for breast cancer in women with proliferative breast disease. N Engl J Med. 1985;312:146-51.
15.
Hutchinson WThomas DHamlin WRoth GPeterson A, and Williams B. Risk of breast cancer in women with benign breast disease. J Natl Cancer Inst. 1980;65:13-20.
16.
. Screening mammography: a missed clinical opportunity? Results of the NCI Breast Cancer Screening Consortium and National Health Interview Survey Studies. JAMA. 1990;264:54-8.
17.
Kirscht J. Preventive health behavior: a review of research and issues. Health Psychol. 1983;2:227-301.
18.
Rosenstock I. The health belief model: explaining health behavior through expectancies. In: Glanz K, Lewis FM, Rimer BK, eds. Health Behavior and Health Education: Theory, Research, and Practice. San Francisco: Jossey-Bass Publishers; 1990:39-62.
19.
King ERimer BTrock BBalshem A, and Engstrom P. How valid are mammography self-reports? Am J Public Health. 1990;80:1386-8.
20.
Kleinbaum DKupper L, and Morgenstern H. Epidemiologic Research: Principles and Quantitative Methods. Belmont, California: Lifetime Learning Publications; 1982.
21.
Kegeles SKirscht J, and Haefner D. Survey of beliefs about cancer detection and taking Papanicolaou tests. Public Health Rep. 1965;80:815-23.
22.
Calnan M. The health belief model and participation in programmes for the early detection of breast cancer: a comparative analysis. Soc Sci Med. 1984;19:823-30.
23.
Meyerowitz BSullivan C, and Premeau C. Reactions of asbestos-exposed workers to notification and screening. Am J Ind Med. 1989;15:463-75.
24.
Schulte P and Ringen K. Notification of workers at high risk: an emerging public health problem. Am J Public Health. 1984;74:485-91.

Comments

0 Comments
Sign In to Submit A Comment

Information & Authors

Information

Published In

cover image Annals of Internal Medicine
Annals of Internal Medicine
Volume 114Number 815 April 1991
Pages: 657 - 661

History

Published in issue: 15 April 1991
Published online: 1 December 2008

Keywords

Authors

Affiliations

Barbara K. Rimer, DrPH
From the Fox Chase Cancer Center, Cheltenham, Pennsylvania. For current author addresses, see end of text.

Metrics & Citations

Metrics

Citations

If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. For an editable text file, please select Medlars format which will download as a .txt file. Simply select your manager software from the list below and click Download.

For more information or tips please see 'Downloading to a citation manager' in the Help menu.

Format





Download article citation data for:
Caryn Lerman, Bruce Track, Barbara K. Rimer, et al. Psychological and Behavioral Implications of Abnormal Mammograms. Ann Intern Med.1991;114:657-661. doi:10.7326/0003-4819-114-8-657

View More

Get Access

Login Options:
Purchase

You will be redirected to acponline.org to sign-in to Annals to complete your purchase.

Access to EPUBs and PDFs for FREE Annals content requires users to be registered and logged in. A subscription is not required. You can create a free account below or from the following link. You will be redirected to acponline.org to create an account that will provide access to Annals. If you are accessing the Free Annals content via your institution's access, registration is not required.

Create your Free Account

You will be redirected to acponline.org to create an account that will provide access to Annals.

View options

PDF/ePub

View PDF/ePub

Related in ACP Journals

Media

Figures

Other

Tables

Share

Share

Copy the content Link

Share on social media