Mammographic surveillance of asymptomatic breast cancer relatives in general practice: rate of re-attendance and GP- and patient-related barriers

Abstract

Background. Several guidelines have been formulated for mammographic screening of breast cancer relatives. No studies have examined the adherence of GPs and their patients to these recommendations. Objectives. We aimed to determine the rate of re-attendance of breast cancer relatives for mammographic screening requested by GPs and specify the barriers for non-attending follow-up mammography. Methods. The study included all asymptomatic women aged 35 years or older with a first-degree family history of breast cancer, referred for mammography to our department of radiology by their GP between 1 January 1992 and 1 September 1994. Reasons for not re-attending mammography within 2 years were obtained by sending a questionnaire to GPs and, if necessary, telephone calls to GPs or their patients. The questionnaire was accompanied by a reminder, in which we advised re-attendance. The number of women who still underwent repeated mammographic screening within the 2 months following the reminder was determined. Results. In 123 out of 234 patients (52.6%) follow-up mammography had been performed within 2 years. Barriers to undergoing follow-up mammography were GP-related in 70.3% of cases and patient-related in 29.7%. Of the 111 non-re-attenders, 52 (47.7%) still underwent follow-up mammography within 2 months after the reminder. This examination was performed more often if the barriers to re-attendance were GP-related rather than patient-related (57.7% versus 24.2%, 95% confidence interval (C1) 13.0-53.9). Significantly more patients re-attended after the reminder if the GP-related barrier was an insufficient retrieval system rather than disagreement with mammography guidelines (81.3% versus 20.0%, 95% CI 40.4-82.0). Conclusions. Many breast cancer relatives did not undergo regular mammographic screening. Non-re-attendance resulted from a limited degree of acceptance and implementation of the screening recommendations by physicians as well as reluctance of the patient to adhere to such recommendations. A reminder, generated by a radiology department, may increase the performance of follow-up mammography.