Callbacks and Scheduling
On first mammogram, 14% of women have a false-positive result, as do 8% of women who undergo screenings regularly.11 Reducing the time between initial and repeat exams can alleviate the anxiety associated with a positive result, whether false or not. Offering mammography appointments outside the standard Monday-through-Friday, 8-to-5 schedule can help reduce the wait time. It may also minimize the inconvenience of scheduling an appointment around multiple family and work obligations.20
IMPROVING PATIENT EXPERIENCES AND OUTCOMES
Providing consistent, accurate written or verbal information before mammography helps ensure timely, effective mammography.12 Use of an educational handout can eliminate the possibility that important information will be overlooked and can contribute to a positive overall impression of the screening experience.
An important element is to advise the patient of the best time in her menstrual cycle to schedule her exam.
Key Points for the Provider
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Encourage women to familiarize themselves with their breasts.1
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Advise women to undergo a clinical breast exam annually after age 40.1,3
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Encourage patients to schedule mammograms (especially a patient’s first mammogram) during week 1 or 2 of the menstrual cycle.13-15
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Provide the patient with written or verbal information in advance about the procedure and what to expect—including the possibility of a callback.12
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If rescreening is deemed necessary, make a personal phone call to notify the patient.
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Work with your imaging center to offer appointments outside standard business hours and minimize wait time before repeat screening (if needed).20
CONCLUSION
Putting the right information in the hands of the patient (particularly the premenopausal woman in her 40s) is likely to result in an accurate mammographic screening with minimal discomfort. This will help reduce the incidence of false-positive results and remove as many barriers to screening compliance as possible.
REFERENCES
1. American College of Obstetricians–Gynecologists. Practice Bulletin No. 122: Breast cancer screening. Obstet Gynecol. 2011;118(2 pt 1):372-382.
2. American Cancer Society. Breast Cancer Facts & Figures 2011-2012. www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-030975.pdf. Accessed September 20, 2012.
3. American Cancer Society Guidelines for the Early Detection of Cancer. Breast cancer. www
.cancer.org/Healthy/FindCancerEarly/CancerScreeningGuidelines/american-cancer-society-guidelines-for-the-early-detection-of-cancer. Accessed September 20, 2012.
4. US Preventive Services Task Force. Screening for breast cancer: US Preventive Services Task Force recommendation statement. Ann Intern Med. 2009;151(10):716-726.
5. Nelson HD, Tyne K, Naik A, et al. Screening for breast cancer: an update for the US Preventive Services Task Force. Ann Intern Med. 2009; 151(10):727-737.
6. Moss SM, Cuckle H, Evans A, et al. Effect of mammographic screening from age 40 years on breast cancer mortality at 10 years’ follow-up: a randomised controlled trial. Lancet. 2006;368 (9552):2053-2060.
7. Miller AB, To T, Baines CJ, Wall C. Canadian National Breast Screening Study-2: 13-year results of a randomized trial in women aged 50-59 years. J Natl Cancer Inst. 2000;92(18):1490–9.
8. Thomas DB, Gao DL, Ray RM, et al. Randomized trial of breast self-examination in Shanghai: final results. J Natl Cancer Inst. 2002;94 (19):1445-1457.
9. Semiglazov VF, Manikhas AG, Moiseenko VM, et al. Results of a prospective randomized investigation [Russia (St.Petersburg)/WHO] to evaluate the significance of self-examination for the early detection of breast cancer [in Russian]. Vopr Onkol. 2003;49(4):434-441.
10. Tu SP, Reisch LM, Taplin SH, et al. Breast self-examination: self-reported frequency, quality, and associated outcomes. J Cancer Educ. 2006;21(3): 175-181.
11. Miglioretti DL, Walker R, Weaver DL, ET AL. Accuracy of screening mammography varies by week of menstrual cycle. Radiology. 2011; 258(2):372-379.
12. Miller D, Livingstone V, Herbison P. Interventions for relieving the pain and discomfort of screening mammography. Cochrane Database Syst Rev. 2008 Jan 23;(1):CD002942.
13. Morrow M, Chatterton RT Jr, Rademaker AW, et al. A prospective study of variability in mammographic density during the menstrual cycle. Breast Cancer Res Treat. 2010;121(3):565-574.
14. White E, Velentgas P, Mandelson MT, et al. Variation in mammographic breast density by time in menstrual cycle among women aged 40-49 years. J Natl Cancer Inst. 1998;90(12): 906-910.
15. Fowler BA, Casey CE, Cameron GG, et al. Cyclic changes in composition and volume of the breast during the menstrual cycle, measured by magnetic resonance imaging. Br J Obstet Gynaecol. 1990;97(7):595-602.
16. Kornguth PJ, Rimer BK, Conaway MR, et al. Impact of patient-controlled compression on the mammography experience. Radiology. 1993; 186(1):99-102.
17. Poulos A, McLean D, Rickard M, Heard R. Breast compression in mammography: how much is enough? Australas Radiol. 2003;47 (2):121-126.
18. Lambertz CK, Johnson CJ, Montgomery PG, Maxwell JR. Premedication to reduce discomfort during screening mammography. Radiology. 2008;248(3):765-772.
19. Markle L, Roux S, Sayre JW. Reduction of discomfort during mammography utilizing a radiolucent cushioning pad. Breast J. 2004;10 (4):345-349.
20. Engelman KK, Cizik AM, Ellerbeck EF. Women’s satisfaction with their mammography experience: results of a qualitative study. Women Health. 2005;42(4):17-35.