Guerrero M/ Enfermería Investiga Vol. 9 No. 2 2024 (April - June)
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CHARACTERIZATION OF USERS OF SCREENING AND DIAGNOSTIC MASTOGRAPHY
María Violeta Guerrero Martínez1 https://orcid.org/0009-0007-7008-9871, Alfonso Reyes López2
https://orcid.org/0000-0002-6249-3678, Nuria Aguiñaga Chiñas3 https://orcid.org/0000-0002-3339-5809,
Guillermo Cantú Quintanilla4 https://orcid.org/0000-0002-3493-2207
1Master in Bioethics from the Faculty of Health Sciences, Universidad Panamericana, Mexico City, Mexico
2Research Professor at the “Federico Gómez” Children's Hospital of Mexico, Mexico City, Mexico
3Specialty in Clinical and Health Psychology from the Faculty of Health Sciences, Universidad Panamericana, Mexico
City, Mexico
4Research Professor at the Interdisciplinary Center of Bioethics of the Universidad Panamericana, Mexico City, Mexico
2477-9172 / 2550-6692 All Rights Reserved © 2024 Technical University of Ambato, Nursing Career. This is an open access article
distributed under the terms of the Creative Commons License, which permits unlimited use, distribution, and reproduction in any medium,
provided the original work is properly cited.
Corresponding author: Dr. Guillermo Rafael Cantú Quintanilla. Email:gcantu@up.edu.mx
Received: December 15, 2023
Accepted: February 1, 2024
ABSTRACT
Introduction: The incidence of breast cancer has increased and there are areas aimed at timely diagnosis
and intervention, identifying the screening capacity of the Mexican healthcare system, which is the main
area of opportunity. When patients are informed, anxiety decreases and their psychological state improves.
Objective: Explore the characterization of users of screening and diagnostic mammography for breast
cancer, in the private healthcare area of Mexico. Methods: Data from 150 women were collected in a
spreadsheet and analyzed in Stata. Univariate analysis for continuous variables and relative frequencies for
qualitative variables were used. The relationship between quantitative variables was explored using scatter
plots. Results: The survey found that women scheduled for mammograms, although they have moderate
concerns. This shows a strong link between their level of knowledge about the procedure and their concern.
Personal and medical characteristics did not significantly affect this concern. Conclusions: Patients with
more information about mammography had a lower level of concern.
Keywords: breast cancer, information, mammography, autonomy
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INTRODUCTION
In recent years, the incidence of breast cancer has
increased, being the most common cancer in
women according to the World Health Organization
(WHO), representing 16% of all cancers in women
(1). It is estimated that 1.38 million new cases are
detected each year and this figure continues to
increase (2). This condition occurs more frequently
in developed countries, possibly due to increased
life expectancy, urbanization and changes in
lifestyle, but it has a greater impact on the population
of developing countries such as Mexico (3). In the
country, the situation of breast cancer is not
encouraging because it represents the leading
cause of death from neoplasms in Mexican women
(4).
The WHO states that early detection is a
fundamental strategy because through timely
diagnosis and appropriate treatment it is possible to
reduce the impact of the disease (3). For this reason,
preventive campaigns should focus on performing
mammograms or, in countries with lower per capita
income, on the use of self-examination as a
technique for detecting palpable lesions (3).
Currently, there is little investment in prevention
programs in developing countries and little response
from the population due to the lack of training in
health personnel and the low awareness of the
needs of this at-risk group (5).
One of the main issues in Mexico is the improvement
and expansion of screening aimed at promoting
early detection of breast cancer. In developed
countries, screening programs are applied and have
facilitated early detection and timely treatment of
breast cancer, giving patients a better quality of life.
These campaigns have proven to be highly
effective, which is why they have also begun to be
replicated in developing countries (6). Available data
suggest that only between 5 and 10% of cases in
Mexico are detected in the initial stages of the
disease (localized in the breast) compared to 50%
in the United States (7).
According to the Pan American Health Organization,
in 2012 breast cancer was the most common type of
cancer in Latin America. By 2030, the same
Organization estimates that the prevalence will
increase by 46%. In Mexico, breast cancer in
women over 20 years of age is the second cause of
death (8) and the first cause of cancer-related
mortality (9). Most cases are detected in advanced
stages, when the probability of 5-year survival with
treatment is less than 30%. Additionally, costs to
women, their families, and the health system are
higher, and treatments are more difficult, more
invasive, and less effective (8).
It is important to highlight the role of information and
recognize that citizens need to know the risks to
which they are exposed in order to act accordingly.
Researchers must address gaps in knowledge to
generate better practices in health promotion, as
well as develop better technologies, programs, in
order to establish better policies and clinical care (8).
Access to information about breast cancer,
accompanied by better medical care, could promote
greater survival, as happens in developed countries
(10).
Over a 10-year period and for every 1,000 women
undergoing mammographic screening, it is
observed that between 167 and 251 receive
abnormal results and are called for further testing, of
which approximately 56 to 64 undergo at least one
biopsy. Additionally, between 9 and 26 cases of
invasive cancer and three to six cases of ductal
carcinoma in situ (DCIS) are detected through
screening. Compared with women who refuse
screening, a reduction of 0.5 to 2 deaths from breast
cancer is observed during this period, depending on
the age of the women (11).
Recent increases in the use of mammography have
led to a decrease in breast cancer mortality.
Likewise, there is evidence that when patients are
informed about the diagnosis and the interventions
they will have, their feeling of control increases,
anxiety is reduced and their psychological
adjustment to the disease situation improves (12).
One research project assigned women to one of
three intervention groups: no educational materials
(usual care), standard materials, or adapted and
personalized materials. Those in the latter group
received materials based on their stage of adoption
for mammography. The primary outcome was
obtaining repeated mammograms, and women in
the group with tailored and personalized materials
were found to be more likely to obtain them
compared to those in the group without materials
(13).
This demonstrates the urgent need for health
education to promote early diagnosis of cancer and
timely treatment which the basis for improving the
quality of care for patients with breast cancer (10,
14). Furthermore, it contrasts with the findings of an
analysis of 58 pamphlets revealing that information
on mammography often focuses on incidence rather
than mortality, which is worrying given that
screening reduces mortality, but not incidence, and
can increase it by detecting harmless diseases (15).
A study of women in European and American
countries examined the understanding of the likely
benefits of mammography and found widespread
misconceptions. Most women believed that
screening prevents or reduces the risk of getting
breast cancer, or at least breast cancer mortality is
reduced by half. They also believed that 10 years of
regular screening will prevent 10 or more breast
cancer deaths per 1000 women (16). The greater
number of correct answers was positively
associated with a higher educational level and
negatively associated with having had a
mammogram in the last 2 years. The results suggest
that a high rate of women overestimate the benefits
that can be expected from mammographic
screening, raising questions about informed consent
procedures in breast cancer screening programs.
The main objective of Health Literacy is to enable
individuals to make informed and autonomous
decisions about their health. When facing health
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problems, we look for answers first in those close to
us, such as family or friends. However, depending
on the topic, broader sources are also used, such as
the Internet, which offers a large amount of
information (17). The challenge lies in teaching the
population to discern between useful information
and that which is not, avoiding overinformation or
misinformation.
Research found that presenting information about
the benefits of cancer screening in different ways
affects an individual's decision to accept or reject
screening. Respondents were more likely to accept
screening when the benefits were presented as a
reduction in relative risk, and more likely to reject it
when they were presented as the number of
screenings needed to save a life (18). Healthcare
professionals face the challenge of balancing
presenting benefits in a positive way to improve
participation rates, with the need to provide
information in a balanced way to facilitate informed
choice.
There are three measures that seem essential to
extend the scope of existing programs for the
detection of breast cancer (9): 1. Raise awareness
among the population about the growing importance
of this problem, 2. Recognize early detection as the
key to control. of this disease and 3. Fight against
the cultural barriers that prevent its rational
approach.
The best practice when reporting is to individualize
the information to the patient as much as possible,
which requires great skill on the part of the
healthcare professional. It is vital that the difficulties
when communicating bad news, such as the
emotional impact, are recognized (19).
Communication and access to information for
patients is an excellent strategy to improve
promotion, prevention, diagnosis and rehabilitation.
So, it is necessary to normalize the use of
communication strategies in health environments,
considering all levels of intervention to which a
person is exposed.
Frequently, it is reported that the personnel in
charge of providing care to patients limits
themselves to informing them about the basics for
performing mammography (20). What's more,
patients begin to ask various questions, not only
related to the radiographic procedure, but also to
other aspects of mammography. They mainly
question whether mammography represents a
thyroid risk, the level of radiation to which they are
exposed, the degree of pain caused by the
procedure or if it is really the ideal time to have the
study.
Based on what was described above, the objective
is to explore the characterization of users of
screening and diagnostic mammography for breast
cancer, in the private health area of Mexico.
METHODS
The present report arises from a protocol that
explored the characterization of users of screening
and diagnostic mammography for breast cancer in
the private environment, whose results refer to the
baseline conditions of the participants regarding the
information they had before having been subjected
to the intervention. It is a controlled, randomized,
non-blinded trial.
Participants
The sample was census type, consisting of 150
women, who came to request a mammogram at a
private clinic, in the period from October 14 to
December 23, 2016, in Mexico City.
Instrument and procedure
A 14-question questionnaire was designed to
evaluate patients' knowledge and doubts about
mammography, as well as their main source of
information. The first two questions cover
sociodemographic aspects such as sex, age,
occupation and education, while the remaining 12
cover aspects related to the mammography
procedure with multiple choice answers (e.g. yes/no,
not at all/a little/regular/a lot, etc.). The variables it
measures are: the reason for the procedure, the
number of times the procedure has been performed
previously, the degree of concern about the
procedure, the level of knowledge about the
procedure, the main source of information, the
number of doubts about the procedure and the type
of doubts they had.
The instrument was applied prior to the procedure in
the same place where the mammography was
performed. The informed consent was read to them
and the conditions of privacy, trust and comfort were
guaranteed, emphasizing that their participation was
voluntary and could be terminated at any time, and
would not affect their medical care. In accordance
with the guidelines and ethical principles for medical
research on human beings recommended by the
Declaration of Helsinki (21), they were provided with
all the necessary instructions for the proper conduct
of the survey and informed that the use of the
information collected would be with caution,
exclusively for scientific purposes.
Analysis strategies
All data were collected in a spreadsheet for
validation and were subsequently exported to the
Stata program for statistical analysis. A univariate
analysis was carried out by calculating measures of
central tendency and dispersion for the variables on
a continuous scale, while relative frequencies were
obtained for the qualitative variables. The
relationship between quantitative variables was
carried out using scatter graphs.
RESULTS
150 women participated with an average age of 53.9
years (SD ± 9.1 years). Regarding education, those
with a bachelor's degree predominated (37%), with
high school in second place (34%) and postgraduate
in third place (15%). A small percentage of patients
only had secondary education (7%), or primary
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education (6%). Regarding occupation, the majority
said they were housewives (53%), while 29% said
they were employees and 10% worked as
independent professionals. The rest mentioned
some commercial or business activity.
Although the percentage of women who came to
request mammography due to medical indication
predominated (59%), the percentage of women who
came by their own decision (41%) is noteworthy. Of
the total sample, only 11 women came to request a
mammogram for the first time (7.3%). However, in
the rest of the participants, the heterogeneity in the
number of subsequent occasions when they had
taken the test was notable. In this sense, 20 of them
reported having had 10 previous mammograms
13.3%, but a small group of women mentioned
having had 30 mammograms (2.7%). In fact, a
moderate positive correlation (r=0.58) was evident
between the number of previous mammograms and
the age of the participants. The summary of the
sociodemographic data is evident in Table 1 below.
The prevalence of nervousness reported by the women prior to undergoing the mammogram was
characterized as not at all according to the 58.67% obtained, followed by a little level at 22%, which is
interpreted as absence of nervousness, as observed in the table 2 presented below.