Once is enough--why some women do not continue to participate in a breast cancer screening programme

To assess the reasons why many women who have been screened once in a breast screening programme decline an invitation for further screening.

Telephone interview survey of a sample of such women; for questions relating to their experience of previous mammography, comparison to data on a representative sample of first screen attendees. The subjects were women who had attended the first round of the Otago-Southland breast cancer screening programme in 1991-1994, who were eligible for re-screening but had been rescreened; age range 50-62.

From programme records, 86% of women who were eligible for a second screen accepted it. Of the women not recorded as having had a second screen, some had attended for a second screen; some had not been invited until they had become age ineligible and some had received no invitation for re-screening. Of women who had received and declined an invitation for re-screening (n = 81), the major reason (46%) was their previous mammogram being painful. Other factors contributing were illness in themselves or their spouse, practical difficulties arranging time and negative experiences with staff in the previous mammography, although these related to relatively few women. A few women thought mammography would be of no benefit, and a few thought re-screening was unnecessary because their first mammography had been normal, or because they practise self-examination.

Ensuring that all women eligible for further screening do get invited could substantially increase the re-screening rate. Even women who have declined previous invitations should be offered further invitations, as a substantial proportion with to be screened. Flexible and convenient appointment times are the main modifiable logistic issue. The major factor influencing non-participation with further screening is a painful experience of mammography. Innovative approaches, either to reduce the pain or to reduce the impact of the pain on the woman's attitude to re-screening, should be trialed.