Breast Screening

Reasons for not attending breast screening

The National Health Service Breast Screening Programme (NHSBSP) was set up in 1988. Women between the ages of 50 and 70 are now routinely invited for free screening every three years. Screening is for all well women without symptoms, whether they have a family history of breast cancer or not. Women over 70 are encouraged to make their own appointments.

Some women choose not to attend for breast screening. Others attend on some occasions and not others. Women's reasons for non-attendance vary - some don't go because they feel they are too busy. Others are deterred by the pain or discomfort of having a mammogram. Some women choose not to go because they feel fit and healthy and do not think they are at risk of developing breast cancer. Studies suggest that a few women don't go for screening because they are afraid of being diagnosed with breast cancer. Other research has found that some women are put off going if they've had a false positive result - one where something is seen on the mammogram but this turns out not to be cancer (see 'False positive results'). Being referred to a breast clinic for further tests after screening can be worrying and can deter women from attending in future.

A British Chinese woman, who was running a family business, said she missed several screening appointments because she was extremely busy with work. When her husband suggested there was no need to attend if she felt fit and well, she decided not to go until she was less busy. She had also been put off from attending a second time because her first mammogram had been painful. She hadn't heard of breast screening before she was invited and said that her daughter translated the invitation letter for her. Language barriers and poor access to information about breast screening can sometimes deter some women from attending.

Missed some screening appointments because she was too busy and felt healthy. (Translated from...

Text only
Read below

Missed some screening appointments because she was too busy and felt healthy. (Translated from...

Age at interview: 65
Sex: Female
HIDE TEXT
PRINT TRANSCRIPT
At first I didn't want to attend because I was doing the business and really busy so you know I missed two appointments. My husband said, you know, if you feel nothing, nothing happens, you don't need go to there. When he said that, because I'm, I'm busy, I just you know didn't want to go as well. Its about three months. I missed two appointments, first I didn't go there and then they gave me another appointment, a letter, and I missed the appointment one month later and then I did not go. I didn't throw any of the letters away. I just you know did not attend it. 

One woman, who found the mammogram extremely painful, chose not to go for breast screening for many years. Another, who'd had a benign (non cancer) condition when she was in her late twenties, said she was too frightened to go for screening. She noted that some cancers don't show up on mammograms and sometimes mistakes are made with the results. She wondered if there was any point in being screened if the results couldn't be trusted.

Found mammograms extremely painful and chose not to attend for screening for many years.

Text only
Read below

Found mammograms extremely painful and chose not to attend for screening for many years.

Age at interview: 68
Sex: Female
HIDE TEXT
PRINT TRANSCRIPT

And I really was literally bent over in pain when I came out. And not everybody finds it painful, some do. So foolishly I said I'm not going back for any more, and I didn't. 

When you got the results back off that'?

That was all right, clear. Yes, that's right. And I should have gone back I think about three years later, but I didn't.

Yeah. And then three years later again, you didn't?

That's right. I'm just trying to think how long afterwards. Well I'm coming up for five years now, so it was before - it was in the last twelve years.
 

Felt too frightened to go for screening and wondered whether the results can be trusted since...

Text only
Read below

Felt too frightened to go for screening and wondered whether the results can be trusted since...

Age at interview: 53
Sex: Female
HIDE TEXT
PRINT TRANSCRIPT
In 78, 79, I went to my GP because I had a lump. He said it was nothing to worry about but I did worry about it. Then I got to the point where I actually was too frightened to do anything else about it. I was getting in such a state that a friend of mine picked me up from work one lunch time and took me straight up to emergency in the local hospital.

They sat me in front of the mirror and said "Look your left breast is much bigger than the right breast, you can see that there's something wrong." And so I changed my doctor immediately to another GP who had me in hospital within a week and I had the lump out. That did make me more aware but in a way also more frightened so I didn't go for any more mammograms. I have been called for a few because of my age but didn't go.

When they send you the letter telling you about the results, and we know this from the media as well, they say "sometimes we make mistakes." So it's kind of well, so really I don't know, I'm no better off than I was before so may be I just won't have the anxiety and I won't go and have a mammogram. I know that sounds ridiculous, like an ostrich putting it's head in the sand, but sometimes you think may be that's the better way to be.

I think they could improve the process because really when you get the results they tell you again that they could've made a mistake. And sometimes they make vast mistakes on batches of women who have had the mammogram so you wonder really whether you're better off. 

A few women had been diagnosed with an early form of breast cancer (Ductal Carcinoma in Situ - 'DCIS') through screening. They had reservations about being screened for a condition that doctors didn't fully understand. One of these women chose not to have any more routine mammograms. She didn't see the point of her going for breast screening again and felt that it would be like 'looking for trouble'. She criticised the current NHS breast screening leaflet for not sufficiently spelling out the benefits and risks of breast screening and for not including a visual representation of breast cancer diagnoses and deaths in women who are screened compared with those who aren't. Several women stressed that attending for breast screening was a personal choice and should be an informed choice.

Discusses why she will have no more screening after her DCIS diagnosis.

Discusses why she will have no more screening after her DCIS diagnosis.

Age at interview: 69
Sex: Female
SHOW TEXT VERSION
PRINT TRANSCRIPT
Bearing in mind that most breast cancers are found by the women themselves anyway, and bearing in mind that I know a thing or two now, what is the window of opportunity for finding something that might be significant? I prefer to take a more sort of sane and balanced view about going and looking for trouble. 

So either I will or I won't, if I get a recurrence, find it in sufficient time. It depends upon the sort of cancer I may or may not get. It might be a tiny, aggressive one, which will be curtains anyway so what good would a screening have done? It might be another ductal carcinoma in situ, which will take another 30 years to get anywhere significant so, bearing in mind how old I am [laughing] does that matter?  I think not. 

So, and my philosophy is today is the day that matters. You know, be reasonably sensible about what's life but don't go looking for trouble and don't think you can guard against all the uncertainties and quirks that are going to go and flip you round the ear because I'll probably die of double pneumonia or something when it comes to it (laughs). 

Says that going for screening is an individual choice and should be an informed choice.

Says that going for screening is an individual choice and should be an informed choice.

Age at interview: 60
Sex: Female
SHOW TEXT VERSION
PRINT TRANSCRIPT
If someone was thinking of going for a mammogram but they weren't very sure, maybe because of the pain, what would you say to them. A friend for example?

Well it's always an individual choice, isn't it, in this day and age one's always got to make up one's own mind. And there is a lot of information to help you make up your mind and I suppose one of the routes of information is getting it from friends and colleagues and particularly people who've been before you. 

Some women noted that, although they went for breast screening, they knew people who didn't. One said that some of her relatives didn't go for screening and that some women don't attend because they are afraid of being diagnosed with breast cancer.

Some of her relatives don't attend for screening and this can be because of fear.

Some of her relatives don't attend for screening and this can be because of fear.

Age at interview: 54
Sex: Female
SHOW TEXT VERSION
PRINT TRANSCRIPT
Unfortunately, even some relatives of mine still don't go, even though they know my history so you can't always convince everybody, but...

Why do you think people don't go, even relatives when they know what ...? 

I think it's fear of knowing. I think it's the fear that, you know, whereas most people who go think they're going to be told everything's okay, perhaps there are a certain group of people who fear that they're going to be told everything isn't okay and that's why they can't face going, I don't know. But it's much better to know early than late.

Last reviewed March 2016.

Last updated March 2016.

Copyright © 2024 University of Oxford. All rights reserved.