Mammography is a screening tool that using low energy x-rays imaging modality for early detection of breast cancer. This early detection tool of breast cancer is conductive early treatment and increases survival rates . The US Preventive Services Taskforce (USPSTF) recommended women receive mammography screening every 1 to 2 years who aged over 40 years. Due to the success of the implementation of mammography screening to detect early stage breast cancers, the breast cancer mortality rate has been decreasing every year . In Taiwan, a mammography screening policy started in 2004 that offered mammography every 2 years to all women aged 45 years and over. Based on this policy, the screening rate keeps increasing per year. In 2015–2016, women who received mammography between 40 to 69 years reached 1,561,477 people, that the screening rate was 38.1%; and the five-year overall survival rate of breast cancer regardless the disease stage was as high as 90% .
Psychological aspects of benign breast disease have also been studied since 1990s, most health providers think women who were undergoing mammography might be healthy people, few study focus on this population. However, when women undergo mammography, most women feel painful from breast compressions, 50% of women reported experiencing severe pain. Additionally, the pain was reported by some patients up to four days after the mammogram, which might deter women who had non- symptoms of breast cancer from breast cancer screening attendance . Nevertheless, some of this population might have some history of breast diseases, such as extremely dense breasts, fibroglandular densities. Also, those who age 45 years and over might be experiencing menopauses; in this situation, hormone replacement therapy for menopause might affect the propensity for high breast density, which increases the likelihood of false-positive results . When non-cancer patients undergoing the radiological examination or waiting for the results, they may experience anxiety, uncertainty, and this may be aggravated in those who also received cancer examination . Evidence supports that women who were waiting for the results of cancer screening from mammography or sonography are stressed and fearful. The anticipation of potential cancer diagnosis creates emotional distress. Other studies have reported that it is even more bothersome for women with benign diseases that require additional, regular follow-ups; cancer-related worries and distress are common and may increase over time, even in those with healthy screening results [8, 9]. When women undergoing breast cancer screening, they may present some responses such as worry about the results, fear of pain, suspicion, uncertainty, anxiety and depression; all of these responses may affect their Quality of Life (QoL) [10–11].
QoL is a life perception in the context of the culture and value systems that include subjective and multi-oriented, involving physiology, role, psychology, spirit and feeling of good health and it’s an important indicator of health care outcome . Many factors could have affected QoL. Currently, most studies focus on cancer treatment, palliative stage and survival of cancer patients . Only few studies have been performed on cancer screening populations [10, 14]. Previous studies most concentrated on obtaining QoL cost-effectiveness analyses for use of mammography . However, these papers didn’t cover intangible costs and benefits, such as the anxiety, depression and discomfort associated with screening and diagnostic examinations .
QoL is an important health issue in breast cancer screening population. Studies have reported that anxiety and depression were significant predictors of QoL. Research on women who have abnormal report of Pap smear indicated that they experienced higher anxiety and lower QoL . In addition, some studies have reported 37% of women who with benign breast tumor had anxiety and depression, while anxiety and depression could affect QoL when they were examined by breast ultrasound . In another study showed women who had benign breast tumors experienced significantly more anxiety (β= -0.354, p < .001) and depression (β= -0.331, p < .001), this situation significantly influenced their QoL . Lee, Hardesty, Kunzler, and Rosenkrantz indicated that women who were undergoing mammography might have fear of pain from examination and experience some psychological impacts including being worried about the examination results, uncertainty, anxiety and depression which may reduce QoL .
According to the literature review, some cancer related studies had explored the factors associated with QoL, but few studies were done in the cancer screening populations. Therefore, the purpose of this study was to examine the distribution of emotional distress, uncertainty, and the QoL, also to explore the factors associated with QoL among women undergoing mammography.