Every October you can’t miss the wealth of information and encouragement around Breast Cancer Awareness Month. But did your patients take action and schedule their annual mammograms?
We already know the facts: it’s estimated that one in eight women in the U.S. will be diagnosed with invasive breast cancer in her lifetime. However, mammogram screenings are only at 85.3 percent of pre-COVID-19 numbers. Despite knowing the risk, encouraging your patients to get back on track with their annual mammograms can be difficult.
We want the best for our patients, but they may have certain circumstances or reservations that keep them from scheduling this important, preventative appointment. Helping them overcome their hesitation or find solutions to what’s limiting their ability to seek care can take time and perseverance.
I’ve found from working with my colleagues at Virginia Women’s Center and our physician-led medical group partner, Privia Women’s Health, that there are two main avenues women’s health clinicians can take to help their patients: listening to their stories and updating your healthcare technology.
Understanding Why Your Patients Say “No”
There are many reasons a patient may hesitate to get a mammogram, and these are some of the more common ones:
- “It’s uncomfortable.” Explaining that the procedure is relatively quick (30 minutes, in most cases, with less than a minute of breast compression in total) and giving them tips to prepare can help ease their mind. You also can suggest that they schedule their mammogram at the same time as a friend or family member so they don’t have to go alone.
- “I don’t have a family history of breast cancer.” Patients may attribute their risk of developing breast cancer to their family history, but only about five to 10 percent of women with breast cancer have a family history of the disease. Discussing this misconception with patients and keeping mammography signage in your office may help drive the conversation.
- “I’ve heard I don’t need one until I’m 50.” Educate patients that screening should begin at age 40. One in six breast cancers occurs in women ages 40 to 49. When women are diagnosed in their 40s, they are more likely to have early-stage disease, negative lymph nodes, and smaller tumors. Roughly one-third of all breast cancers in Black, Asian, and Hispanic women occur under age 50. Delaying mammography until age 50 adversely affects these populations. Depending on their health history, some patients should start earlier than 40.
- “I’ve been told I no longer need a mammogram.” Dispel the myth that mammography should stop at a particular age. One in 24 breast cancers occurs in women 75 years or older, therefore it is recommended that screening continues without an upper age limit unless severe medical conditions or diseases limit life expectancy or the ability to receive treatment.
- “I don’t want to know,” or “I heard mammograms don’t work.” Some patients are too afraid to find out or don’t believe in mammograms, but it’s vital they know early detection makes a significant difference in reducing potentially serious situations down the road. Studies show that the five-year relative survival rate of stage 1 breast cancer is 91 percent. Establishing a sense of urgency while acknowledging that no test is foolproof, is one way to steer them toward scheduling an appointment.
- “I’m concerned about the risks of mammography.” The scientific community agrees upon a potential risk of solid organ cancers for radiation exposure over 100 mGy. The average radiation exposure of today’s mammography is three mGy, which is similar to about six weeks of natural “background” radiation. There are no documented cases of radiation-induced breast cancer at that level of exposure and lives saved by screening mammography far outweigh the patient’s theoretical risk.
- “I’m healthy.” While maintaining a healthy lifestyle can help, it will not eliminate the risk.
- “Do I need a mammogram if I identify as a transgender woman or transgender man?” Transfeminine (male-to-female) patients who have used hormones for five years or less and transmasculine (female-to-male) who have not had a mastectomy should start annual screening at age 40. Individuals who carry mutations BRCA1 or BRCA2 genes are at much higher risk of developing breast cancer than their genotypic counterparts. Screening for these patients should be assessed on a case-by-case basis.
Keep Mammograms Front and Center
In addition to understanding why your patients are reluctant to get their annual mammograms, take a look at your healthcare technology. How does it work for you and your patients? Does it make it easy for your patients to schedule their appointment? At Virginia Women’s Center, we have found online scheduling of appointments including screening mammography to be very convenient and well received by our patients.
Digital alerts that remind patients to call your office or their specialist and schedule a mammogram may help improve compliance. In a study published in the National Library of Medicine, a primary care practice increased their mammography rates by almost 12 percent by calling their patients and reminding them to make an appointment. For example, Privia Women’s Health’s technology alerts our women’s health clinicians to care gaps that can be resolved at the point of care. Additionally, it automatically sends reminders to patients to schedule their next appointment.
After all the reminders and visibility during Breast Cancer Awareness Month, now is the time to follow up and encourage your patients to check this self-care task off the list. Help them understand the benefits of regular mammograms, stress the importance of early detection, and get them back on the path to regular screenings. In turn, we can empower patients to take control of their care and help them lead longer and healthier lives.