Mammography screening: views from women and primary care physicians in Crete

Background: Breast cancer is the most commonly diagnosed cancer among women and a leading cause of death from cancer in women in Europe. Although breast cancer incidence is on the rise worldwide, breast cancer mortality over the past 25 years has been stable or decreasing in some countries and a fall in breast cancer mortality rates in most European countries in the 1990s was reported by several studies, in contrast, in Greece have not reported these favourable trends. In Greece, the age-standardised incidence and mortality rate for breast cancer per 100.000 in 2006 was 81,8 and 21,7 and although it is lower than most other countries in Europe, the fall in breast cancer mortality that observed has not been as great as in other European countries. There is no national strategy for screening in this country. This study reports on the use of mammography among middleaged women in rural Crete and investigates barriers to mammography screening encountered by women and their primary care physicians. Methods: Design: Semi-structured individual interviews. Setting and participants: Thirty women between 45–65 years of age, with a mean age of 54,6 years, and standard deviation 6,8 from rural areas of Crete and 28 qualified primary care physicians, with a mean age of 44,7 years and standard deviation 7,0 serving this rural population. Main outcome measure: Qualitative thematic analysis. Results: Most women identified several reasons for not using mammography. These included poor knowledge of the benefits and indications for mammography screening, fear of pain during the procedure, fear of a serious diagnosis, embarrassment, stress while anticipating the results, cost and lack of physician recommendation. Physicians identified difficulties in scheduling an appointment as one reason women did not use mammography and both women and physicians identified distance from the screening site, transportation problems and the absence of symptoms as reasons for non-use. Conclusion: Women are inhibited from participating in mammography screening in rural Crete. The provision of more accessible screening services may improve this. However physician recommendation is important in overcoming women's inhibitions. Primary care physicians serving rural areas need to be aware of barriers preventing women from attending mammography screening and provide women with information and advice in a sensitive way so women can make informed decisions regarding breast caner screening

Health technology assessment in the area of prevention - Selected screening cases in Greece

Objective: To explore the impact of health technology assessment (HTA) on health policy and practice in Greece through selected screening case studies in the prevention area. The three cases studied were mammography screening, PSA screening, and routine ultrasonography in normal pregnancy. Methods: Official policy recommendations or reports, a literature review of Greek published research as well as gray literature from various sources, and interviews with specialists and medical associations were performed, and their impact on health policy formulation was examined. Results: The implementation of the screening tests does not take the form of structured mass screening programs. Almost all physicians (urologists-pathologists, gynecologists) apply PSA and routine ultrasonography in normal pregnancy respectively with the purpose of either prevention or diagnosis. Mammography is applied generally for prevention or diagnosis, but there are some mass screening programs at a local level. In addition, the results show no evidence that the efficacy and the cost-effectiveness of the three screening programs have been a matter of serious concern and investigation for the purposes of policy formulation in Greece. Conclusion: The results point to a need for the implementation of HTA methods on mass screening preventive programs in which real value and cost remain unclear and whose use is based on empirical and personal assessments