Thesis (Ph.D.)--Oregon Health & Science University, 2005
Although much research has focused on factors associated with mammography adherence, few studies have addressed how older women with a breast cancer family history make decisions about whether or not to have mammograms. A convenience, volunteer sample of sixteen Caucasian women ages 67 to 85 with one to three first-degree relatives diagnosed with breast cancer participated in this qualitative grounded theory study. Fourteen were receiving regular mammography screening. Grounded theory methodology was used to generate a theory concerning how older women with a family history of breast cancer make screening mammography decisions. Qualitative data was collected in person using semi structured interview questions and a demographic questionnaire during one to two interviews
Being "always on guard for breast cancer", describes the process women went through when making mammography decisions. Women had a heightened awareness of their breast cancer risk and were "always on guard for breast cancer" because it is an ever present threat in their lives. The decision to begin having regular mammograms often began after having a family member diagnosed with breast cancer. A negative mammogram gave women peace of mind and assurance that breast cancer was not present. Being called back for additional mammograms or other follow up tests often caused worry, anxiety and breast cancer fear, especially when receiving test results was delayed. Women were not receiving adequate clinical breast exams or being referred for genetics services when at risk for a hereditary cancer syndrome. Health care providers need to schedule follow up mammograms as soon as possible, minimize the time it takes to report test results, provide a complete annual clinical breast exam, obtain a family history of cancer, and refer women with a strong family history of cancer for genetic services
Future research needs to examine the negative emotional consequences of abnormal mammograms such as worry, anxiety, and cancer fear and test interventions such as providing same day follow up tests, shortening the time to it takes for a woman to receive test results, and providing emotional support
