An ongoing argument over the value of mammography in women aged 40 to 49 years has left both physicians and patients confused. While physicians pick and choose which recommendations they believe are best for patients, no one knows what the patients themselves believe.
In the May issue of the Archives of Internal Medicine, Woloshin and colleagues report on a survey designed to discover what American women understand about mammography screening. 800 women aged 18 years and older were were randomly polled by mail between August and October of 1997. Women of screening age were deliberately oversampled. Sixty-six percent (503) of the returned, eligible surveys were analyzed.
The study's authors selected 3 main outcome measures: the women's reactions to the debate, their interpretation
of the appropriate age for first mammogram, and their perception of the source of the debate.
The vast majority of respondents (95%) reported following the screening debate. However, only 24%
reported that the debate had improved their understanding of mammography and half felt that the public
disagreement of experts was distressing. Women did not subscribe to the prevailing positions currently
proposed by experts. A majority (83%) believed that mammography had proven benefits in women ages
40 to 49 years and 38% believed that screening had proven benefits in women aged 39 years and
younger. Most women also felt that mammographic screening should begin before age 40 years; fully half
believed that screening should begin at age 35 years or younger, while only 5% felt that screening should
begin at age 50 years or older.
When asked why mammography is controversial, women cited the tendency of experts and studies to
disagree (27%), concerns about the potential harm of radiation (15%), lack of accuracy of mammograms
(14%), and questions about efficacy (12%). However, nearly half (49%) of the women cited institutions'
reluctance to cover costs as the major source of the debate, while less than 1% cited dispute over the
mortality-reducing benefit of mammograms in women aged 40 to 49 years.
These findings suggest that women have been attentive to the mammography debate, but that most have
misperceptions about the source of conflict and the existing knowledge base. The authors conclude that
mammography policy makers need to work to improve the way their messages are delivered to and
interpreted by the public.