Research article

Mammography screening: views from women and primary care physicians in Crete

Maria Trigoni^{* 1} , Frances Griffiths^{* 2} , Dimitris Tsiftsis^{* 3} , Eugenios Koumantakis^{* 4} , Eileen Green^{* 5} and Christos Lionis^{* 6}

¹University of Crete, Head of Department of Social Work, University Hospital of Heraklion, Crete, Greece

²Health Sciences Research Institute, Warwick Medical School, University of Warwick, UK

³Head of Department of Surgical Oncology School of Medicine, University of Crete, Greece

⁴Head of Department of Obstetrics and Gynecology School of Medicine, University of Crete, Greece

⁵Director of Centre for Social and Policy Research, University of Teesside, UK

⁶Head of Clinic of Social and Family Medicine, School of Medicine, University of Crete, Greece

author email corresponding author email* Contributed equally

BMC Women's Health 2008, 8:20doi:10.1186/1472-6874-8-20

Published:	7 November 2008

Abstract

Background

Breast cancer is the most commonly diagnosed cancer among women and a leading cause of death from cancer in women in Europe. Although breast cancer incidence is on the rise worldwide, breast cancer mortality over the past 25 years has been stable or decreasing in some countries and a fall in breast cancer mortality rates in most European countries in the 1990s was reported by several studies, in contrast, in Greece have not reported these favourable trends. In Greece, the age-standardised incidence and mortality rate for breast cancer per 100.000 in 2006 was 81,8 and 21,7 and although it is lower than most other countries in Europe, the fall in breast cancer mortality that observed has not been as great as in other European countries. There is no national strategy for screening in this country. This study reports on the use of mammography among middle-aged women in rural Crete and investigates barriers to mammography screening encountered by women and their primary care physicians.

Methods

Design: Semi-structured individual interviews. Setting and participants: Thirty women between 45–65 years of age, with a mean age of 54,6 years, and standard deviation 6,8 from rural areas of Crete and 28 qualified primary care physicians, with a mean age of 44,7 years and standard deviation 7,0 serving this rural population. Main outcome measure: Qualitative thematic analysis.

Results

Most women identified several reasons for not using mammography. These included poor knowledge of the benefits and indications for mammography screening, fear of pain during the procedure, fear of a serious diagnosis, embarrassment, stress while anticipating the results, cost and lack of physician recommendation. Physicians identified difficulties in scheduling an appointment as one reason women did not use mammography and both women and physicians identified distance from the screening site, transportation problems and the absence of symptoms as reasons for non-use.

Conclusion

Women are inhibited from participating in mammography screening in rural Crete. The provision of more accessible screening services may improve this. However physician recommendation is important in overcoming women's inhibitions. Primary care physicians serving rural areas need to be aware of barriers preventing women from attending mammography screening and provide women with information and advice in a sensitive way so women can make informed decisions regarding breast caner screening.