Breast Cancer Survivors Lax About Mammograms

Only 33% get them annually for five years after diagnosis, study finds

Kathleen Doheny

Kathleen Doheny

Updated on April 24, 2006

MONDAY, April 24, 2006 (HealthDay News) -- Breast cancer survivors are good about getting a mammogram right after their diagnosis and treatment, but they become lax about later screenings even though they have a high risk of developing another malignancy, a new study finds.

Only one in three women gets mammograms as recommended during the five years after their diagnosis, researchers report in the June issue of Cancer.

The findings were surprising to the study's lead author, Dr. Chyke A. Doubeni, an assistant professor of family medicine and community health at the University of Massachusetts Medical School, in Worcester. While many women fail to adhere to recommended screening guidelines, he thought breast cancer survivors might be different.

"Some studies indicate if you have a history of cancer, your awareness of your risk is much higher, so we would expect that most breast cancer survivors would get regular mammograms," he said.

When Doubeni and his fellow researchers reviewed mammography use in 797 women over age 55 who had been treated for breast cancer, they found that in the first year after treatment, 80 percent of the women had gotten a mammogram. But by the fifth year of follow-up, only 63 percent of the women had gotten a mammogram that year. And only one in three -- 33 percent -- had gotten a mammogram every year over the five-year study period, as recommended.

Overall, healthy women aren't as faithful to mammograms as health-care professionals would like, other studies have shown. For instance, a study published in Cancer in 2005 found that while three-quarters of women over age 40 say they regularly undergo a mammogram for screening purposes, less than two-thirds actually do. The American Cancer Society recommends women begin getting regular yearly screening mammograms at age 40.

Women who have had breast cancer have about a threefold increased risk of getting cancer in the opposite breast, compared with women who have not had breast cancer, according to Doubeni.

Doubeni said his study uncovered one other troubling finding -- all the women had access to health insurance. "Whether or not someone has insurance is an important factor in the use of mammograms," he said. "In this case, all the people we studied had health insurance."

Exactly why many of the women stop getting regular mammograms was beyond the scope of the study, but Doubeni and other experts have some educated guesses. Over time, he said, many women, including breast cancer survivors, tend to get nonchalant about mammograms, perhaps because they forget to schedule the exam.

In the case of breast cancer survivors, some denial may also play a role, Doubeni said. Or it may be a matter of miscommunication between a woman's oncologist and her internist or family practice doctor who provides her routine care, with one doctor thinking the other one is reminding her to get regular mammograms.

"At least one study out of Canada shows the care of cancer survivors is really fragmented," Doubeni said, with several doctors involved but perhaps no one with overall oversight.

The findings aren't a surprise to Dr. Cheryl Perkins, senior clinical advisor for the Susan G. Komen Breast Cancer Foundation, in Dallas, and a breast cancer survivor herself. "We hear it a lot about mammography in general," she said, referring to women's tendency not to get regular mammograms.

She also speculated that "the longer you are cancer-free, the more 'normal' you feel, and then the cancer survivors begin to behave more like the general population."

Denial could play a role, too, she said, with the women not wanting to think about the possibility of cancer recurring.

Still, Perkins would tell breast cancer survivors that "the earlier you detect anything that might recur, the better your chances to have a successful treatment the next time around."

She recommended that women who have survived breast cancer talk to their primary doctor and be sure he or she knows they have had breast cancer. "Ask for a reminder [about getting a mammogram] if you have trouble remembering. Or figure out ways to remind yourself," she said.

More information

To learn more about mammograms, visit the American College of Radiology.

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