Experts say mammograms can be a stressful experience for any woman, regardless of her medical history. But failure to get the recommended breast cancer screening can only increase a woman's risk by allowing cancers to go undetected.
Despite recommendations for annual mammography among breast cancer survivors, a previous study showed that 30% of these women had not received a mammogram in the previous year and 41% could not recall whether they had a mammogram in the previous two years.
"This raises the question of why women may be reluctant to undergo regular follow-up mammograms," says researcher Maria Gurevich, PhD of Toronto's Ryerson University and Princess Margaret Hospital, in a news release. "Our study suggests that perhaps the experience triggers distressing memories of prior cancers."
Mammograms Induce Stress
In the study, published in the current issue of Psychosomatic Medicine, researchers surveyed 135 women undergoing mammography at a large cancer center in Toronto. About half of the women had survived breast cancer, and the other half had no history of the disease.
All of the mammograms for the women indicated that they were free of cancer. But researchers found that women with a personal history of breast cancer associated mammograms with significant distress, even when the results were negative.
For example, 3% to 26% of breast cancer survivors reported stress symptoms that exceeded the threshold for acute stress compared with only 1% to 11% of women with no history of breast cancer.
Researchers say that since they had already lived an average of 6 1/2 years after their initial breast cancer diagnosis, about two-thirds of the women could expect a favorable mammogram result. But the study showed these women scored even higher on stress scores than women who were newly diagnosed with the disease, as found in previous studies.
Gurevich says those findings suggest that even routine follow-up care and good mammography results can still cause anxiety among breast cancer survivors by triggering memories of earlier bouts with cancer.
"Compared with those with no history of breast cancer, the meaning and experience of mammography surveillance and cancer-related medical follow-ups are likely to be different in survivors of breast cancer, who are at higher risk for developing new primary breast cancer or a recurrence," writes Gurevich and colleagues.
To Know or Not To Know
For women considering a mammogram, experts say it's a struggle between uncertainty and fears about what might be found.
"The problem with mammograms and doing breast self-exams or clinical exams is the only thing you're looking for is bad news," says Bev Parker, director of the Y-ME National Breast Cancer Organization hotline. "I think we all want to shy away from that."
But by undergoing annual breast cancer screening, Parker says women can know that they're safe for another year.
Wendy Mason, helpline manager for the Susan G. Komen Breast Cancer Foundation, agrees and says uncertainty can be much more stressful than the mammogram itself.
"The not knowing is more bothersome to a lot of the women because if they know what's wrong, at that point they can make plans for next steps and start actively doing something -- whether it's treatment or follow-up," Mason tells WebMD. "I think the not knowing causes a lot more sleepless nights."
Mason says that although breast cancer survivors may have a higher level of anxiety about mammograms, they are also keenly aware of the risks of not getting one.
"They wouldn't consider not going for a mammogram because they know that early detection is going to give them the best chance for successful treatment," says Mason.
Although every breast cancer case is different, Mason says the risk of cancer recurrence is greatest within the first two years after diagnosis and that risk decrease with time. Women are considered breast cancer free if no new or recurrent cancers are found within five years after their initial diagnosis.
Taking the Stress Out of Mammograms
The study also found that support from doctors, friends, and family plays an important role in mediating the stress women feel about mammograms.
Strong support from their doctor reduced stress among women who never had cancer, but increased stress levels among women with a history of breast cancer. Researchers say that association doesn't necessarily mean that the doctors caused their patients' symptoms, but the patients' distress may have stimulated the doctors' concern.
Mason says that finding underscores the point that open communication between the doctor and patient is critical to easing women's fears about breast cancer screening.
Cheryl Perkins, MD, senior clinical advisor at the Komen Foundation says asking questions at the time a mammogram is scheduled can help allay women's fears up front. Those questions should include:
- What can you expect during the procedure itself?
- What is the follow-up plan?
- How much time is required to receive your results?
- How accurate are those results likely to be? What is the risk of a false-positive result?
- What would be done depending on those results?
For family and friends of women who are fearful about a mammogram, Parker says it's important to listen and remind them of the positive side of breast cancer screening.
"Try to validate her feelings and tell her that most women feel the way she does," Parker tells WebMD. "It's just something to get through, and she'll have that peace of mind on the other side of it."
For fact sheets and other information on what to expect from a mammogram and other breast cancer issues, contact the toll-free helpline at the Susan G. Komen Breast Cancer Foundation at (800) I'M AWARE or the Y-ME hotline at (800) 221-2141.