Mammography Adherence: Results of a Focus Group Study

Epidemiological reports suggest mammography adherence has declined. Given that mammography accounts for at least half of the decrease in breast cancer mortality, understanding this decline is critical. We conducted a focus group study to explore why some women discontinue routine mammographic screening. Nineteen focus groups and one dyad interview were conducted with white non-Hispanic (WNH), black non-Hispanic (BNH), Hispanic, Japanese American (JA), and Native American (NA) women who were segmented by age (43-49, 50-64, 65+), race/ethnicity and health insurance status. A conceptual framework, based on existing research, informed development of the focus group guide.Topics included previous mammography experiences, perceptions of personal breast cancer risk, barriers to mammography, and risks and benefits associated with undergoing mammography. Atlas.ti was used to facilitate data analysis. All focus groups (n=128 women) were completed in 2009 in five cities across the United States. Half of the groups were held with WNH women and the remainder with other racial/ethnic groups. Major barriers to routine mammography included 1) lack of awareness that risk increases with age; 2) doubts about the safety, accuracy, and benefits of mammograms; 3) distrust of providers and medical system; and 4) physical and emotional discomfort associated with the screening procedure and mammography technicians. For uninsured women, lack of health insurance was the primary barrier to mammography. The findings direct us to social media marketing that would allow crafting and tailoring of messages and materials to address the barriers women face through traditional channels (e.g. print media) and newer social media (e.g. Facebook, blogs).