Engaging Patients in Annual Mammograms

The National Cancer Institute estimated that over 280,000 women aged 65 to 74 were diagnosed with breast cancer in 2020, which made it the most common cancer in women for that year. Mammography, while not foolproof, is one of the best ways to detect breast cancer in early stages.

In 2019, 66.7 percent of women aged 40 and older stated they have had mammograms in the past two years. These results are positive, as evidence shows that the combination of earlier cancer screenings and cheaper treatment leads to a 24 to 33 percent reduction in the overall mortality rate. However, there is always room to improve those numbers.

In honor of Breast Cancer Awareness Month, we assembled resources and information to help engage patients in their care. Here are some of the top things that hesitant patients may need to know that could change their minds about mammograms.

1. Breast Cancer Disproportionately Affects Certain Groups

Not all patients know that breast cancer affects women of all races and ethnicities at different rates.

According to the American Cancer Society, incidents of breast cancer occur in non-Hispanic white women and non-Hispanic Black women at roughly the same rate, but the mortality rates are disproportionately higher in non-Hispanic Black women. This is likely because non-Hispanic Black women are more likely to experience delays in care, receive care from lower-resourced clinics, and longer intervals between the discovery of abnormal results and communication.

While the mortality rate is much lower for women of the Alaskan Natives, Native Americans, Asian and Pacific Islanders, and Hispanic ethnicities, evidence shows that they still receive disproportionate access to preventive care.

While breast cancer occurs almost exclusively in cisgender women, transgender women who have undergone hormone therapy are 17 times more likely to develop breast cancer than cisgender men. It’s critical for physicians to assess patients for their individual risk of developing breast cancer and determine if this patient should receive regular mammograms.

2. Any Woman Can Develop Breast Cancer Regardless of Family History

The top two risk factors for breast cancer are being a cisgender woman and age. Patients may falsely attribute their risk of developing breast cancer to their family history, but only about five to 10 percent of women diagnosed with breast cancer have a family history of the disease. Although rare, five percent of all breast cancer diagnoses occur in women under the age of 40. 

Another common myth patients believe about breast cancer is that maintaining a healthy weight, eating well, and exercising regularly will dramatically reduce her risk. Evidence shows that healthy lifestyle habits can help, but they do not eliminate the need for regular mammograms and monthly self-exams.

Understanding a Patient’s Circumstances

Even if they know their personal risk of developing breast cancer, patients may have social determinants that prevent them from getting mammograms. When discussing mammography with a patient, physicians can learn more about the determinants that affect them personally. Below is a common list of determinants and how physicians can help patients find the resources they need:

• Costs. Unsurprisingly, cost remains a determining factor in whether patients get annual mammograms. The reasons for this are clear: an annual mammogram can cost patients without health insurance up to $890. Thankfully, the Centers for Disease Control and Prevention’s (CDC) National Breast and Cervical Cancer Early Detection Program and Planned Parenthood provide free or low-cost mammograms in all 50 states, including tribal communities. These programs are great options for patients who cannot afford health insurance.
• Pain and embarrassment. Mammogram-adverse patients may avoid them because of poor experiences or the embarrassment of the procedure. In one study, patients were more likely to get their mammograms despite these factors when their physician clearly explained what a mammogram was, what they expected of the patient, what they were looking for in the x-ray, and told them the benefits of getting an annual mammogram. This is where building a relationship with the patient and enhancing the patient experience are key.
• Time. Patients often misunderstand how long it takes to get a mammogram. While it depends on the center that offers the mammogram, telling patients that the test usually takes about 15 minutes can help ease their anxiety. If you are part of a physician group, they may offer in-house mammography services that you can integrate directly into your practice and your electronic health record (EHR). Patients may be more willing to get their mammograms if they do not have to schedule an appointment and travel to another location.
• Don’t want to know. While it sounds contradictory, women are more likely to avoid mammograms if a close friend or relative develops breast cancer. It’s easier not to confront the anxiety directly. However, it’s critical for patients to know that early detection makes a significant difference in the mortality rate. Studies show that the four-year relative survival rate of stage 1 breast cancer is 95 percent. For regional and localized tumors, the survival rates still hover between 86 to 92 percent. Mammograms are not as foolproof as some patients may believe, but they are an excellent tool.

 
Breast Cancer Awareness Month is a great time to help patients understand the benefits of regular mammograms and stress the importance of early detection. Enhancing the patient-provider relationship, improving the patient experience, and providing resources to patients can help them live longer, healthier lives!

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