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

BACKGROUND: Several guidelines have been formulated for mammographicscreening of breast cancer relatives. No studies have examined theadherence of GPs and their patients to these recommendations. OBJECTIVES:We aimed to determine the rate of re-attendance of breast cancer relativesfor mammographic screening requested by GPs and specify the barriers fornon-attending follow-up mammography. METHODS: The study included allasymptomatic women aged 35 years or older with a first-degree familyhistory of breast cancer, referred for mammography to our department ofradiology by their GP between 1 January 1992 and 1 September 1994. Reasonsfor not re-attending mammography within 2 years were obtained by sending aquestionnaire to GPs and, if necessary, telephone calls to GPs or theirpatients. The questionnaire was accompanied by a reminder, in which weadvised re-attendance. The number of women who still underwent repeatedmammographic screening within the 2 months following the reminder wasdetermined. RESULTS: In 123 out of 234 patients (52.6%) follow-upmammography had been performed within 2 years. Barriers to undergoingfollow-up mammography were GP-related in 70.3% of cases and patient-relatedin 29.7%. Of the 111 non-re-attenders, 52 (47.7%) still underwent follow-upmammography within 2 months after the reminder. This examination wasperformed more often if the barriers to re-attendance were GP-relatedrather than patient-related (57.7% versus 24.2%, 95% confidence interval(CI) 13.0- 53.9). Significantly more patients re-attended after thereminder if the GP-related barrier was an insufficient retrieval systemrather than disagreement with mammography guidelines (81.3% versus 20.0%,95% CI 40.4-82.0). CONCLUSIONS: Many breast cancer relatives did notundergo regular mammographic screening. Non-re-attendance resulted from alimited degree of acceptance and implementation of the screeningrecommendations by physicians as well as reluctance of the patient toadhere to such recommendations. A reminder, generated by a radiologydepartment, may increase the performance of follow-up mammography.