Breasts screening satisfaction

Three years into the National Breast Screening Programme, the majority of women who have taken part are satisfied with the services and would recommend having a mammogram to relatives and friends.

Article provided by Danika Attard

Breast cancer accounts for 23% of female cancers worldwide. In both Malta and the UK the incidence of breast cancer is much higher at 32%, making it the highest rate in Europe. 

Breast cancer affects one in eight women, though if it is detected early enough, while it is still in the localized stage, survival rates for the next five years are as high as 98%. Since the opening of the National Breast Screening Programme in October 2009, Maltese women born between 1950 and 1959 have been invited to undergo mammography screening every three years. Presently, the programme is in its initial cycle, though it is set to expand in the future. 

A woman’s experience of her initial screening can influence her decision on whether to participate in subsequent screenings or not. Studies have shown that the physical, psychological and social aspects associated with and resulting from the screening process increase or decrease client satisfaction. 

Previous studies regarding client satisfaction with mammography screening have focused on diverse but specific aspects of the screening pathway, and although such studies have been undertaken in other European countries, this is the first time that we have investigated customer satisfaction with the Malta Breast Screening Programme.

We went about it through a telephone interview survey in 380 women who had already participated in the Programme, including both those with a normal initial screen and those recalled for further tests. The aim was to identify those factors that affect client experience and explore the views of women themselves in order to assess satisfaction with information, waiting time, the physical environment, pain and discomfort, and interactions with staff.

The Results

Women’s experiences of their appointment, care perception and overall programme were described in a very positive way, with all respondents claiming that the service was either “good” (31.3%) or “excellent” (68.7%). 

Women were asked to identify what they liked most at the breast screening unit. Women pinpointed the radiographer’s professionalism who showed “effective communication skills, care and competence” and all the staff at the Screening Centre who were “friendly and helpful”. Many women stated that they were impressed with the efficiency of the service and said that it was “the best” they had ever experienced. Furthermore, all clients were very satisfied with the centre’s environment since they “felt at home”.  “The unit is very clean. The employees are neat. Everything is well kept” (Breast Screening client).

29.7% of participants faced difficulties in accessing the unit due to the “busy road”, “no bus access” and “limited parking”, resulting in less overall programme satisfaction. 

The general public’s perception of the mammography test has sometimes been reported to be one of pain and furthermore, mammography has been reported as painful in worldwide studies. In this local research, those who found mammography “severely uncomfortable” or “severely painful” had a less than excellent score on women’s satisfaction. Nonetheless, many women in this study felt that “the radiographers’ professionalism and effective communication during the test were the leading factors that, in turn, communicated care, confidence and competence to them and their families”. In fact, almost everyone felt at ease and commented that the radiographer provided excellent care. “The ‘contact’ with the Radiographer made all the difference” (Breast Screening client).

More than half of participants experienced anxiety prior to mammography (56.3%) and higher anxiety (92.3%) when recalled for further tests. When attending for further breast assessment, the client majority was still very satisfied with the overall communication. However, those women who underwent a biopsy were less satisfied than non-biopsied women, mainly due to the increased anxiety about the biopsy. Nonetheless, the majority of women stated that they would re-attend for breast screening. Moreover, all clients would recommend screening to others irrespective whether they were recalled for further tests or not. 

Being assured of a female radiographer was an impacting factor in this research, leading to a positive screening experience and consequently high satisfaction. In fact, results show that if the radiographer was male, 68.9% of all women would not have undergone the test. 

This research has contributed to a better understanding of those factors influencing client satisfaction at the Malta Breast Screening Programme. External factors such as location and parking did not influence women’s perception of care within the unit, although a minority faced difficulties with accessing the centre. Social and economic factors proved not to cause inequalities in access to or satisfaction with screening. The internal non-clinical, welcoming ambience within the National Breast Screening Centre has created an atmosphere conducive towards increased women’s satisfaction, proving that the modernization of health facilities greatly contributes towards customer satisfaction and care. The results of this nation-wide study also concur with earlier studies showing high satisfaction among women in other European breast screening programmes.


  • Improving external signage to enhance accessibility to the centre 
  • Providing adequate pre-procedural information to minimize women’s anxiety. 
  • Developing strategies to minimize pain and discomfort 
  • Ongoing service evaluation to ensure that high standards of care are provided and to enable service improvements to meet women’s needs. 
  • Investigate reasons for non-attendance 

Research carried out Danika Maria Attard BSc. (Hons.), MSc. (Lond.), MLJ, LRSM, Senior Radiographer, National Breast Screening Programme, as part fulfilment of a Master of Science degree in Medical Imaging (Mammography), Kingston University London.

The research work in this publication was partially funded by the Strategic Educational Pathways Scholarship (Malta). This scholarship was part-financed by the European Union – European Social Fund (ESF) under Operational Programme II – Cohesion Policy 2007-2013, “Empowering People for More Jobs and a Better Quality of Life”.

Factors that cannot be changed

  • Gender – although men can develop breast cancer it is 100 times more common in women
  • Ageing - About 1 out of 8 invasive breast cancers are found in women younger than 45, while about 2 of 3 invasive breast cancers are found in women age 55 or older
  • Genetics – 5% to 10% of all breast cancers are hereditary. Having a mother, sister or daughter with breast cancer doubles the risk of developing breast cancer
  • Personal history of breast cancer – having breast cancer in one breast increases the risk 3 to 4-fold of developing it in the other breast
  • Dense breast tissue – the denser the breast tissue the more likely it is to develop cancer. Unfortunately it also makes it more difficult to detect
  • Menstrual periods – women who started menstruating before the age of 12 or continue after the age of 55 have slightly higher risk due to a longer lifetime exposure to oestrogen and progesterone

Lifestyle related factors

  • Having children – women who have not had children or had their first child after 30 are at higher risk
  • Birth control – oral birth control pills or injectable progesterone increases the risk of breast cancer due to high. However risk factors return to normal after a woman has stopped taking birth control after 10 years
  • Hormone therapy after menopause – Increasing exposure to oestrogen has been proven to stabilize mood swings but increase the risk of breast cancer
  • Breastfeeding – breastfeeding for 1½ to 2 years may slightly lower the risk of breast cancer though this has been hard to prove as breastfeeding does not normally continue for that amount of time

Symptoms of breast cancer

Though ageing increases the risk of breast cancer every woman over 20 is at risk and should look out for symptoms. 

  • Lump or thickening in or near the breast or in the underarm that persists through the menstrual cycle.
  • A mass or lump, which may feel as small as a pea.
  • A change in the size, shape, or contour of the breast.
  • A blood-stained or clear fluid discharge from the nipple.
  • A change in the feel or appearance of the skin on the breast or nipple (dimpled, puckered, scaly, or inflamed).
  • Redness of the skin on the breast or nipple.
  • A change in shape or position of the nipple
  • An area that is distinctly different from any other area on either breast.
  • A marble-like hardened area under the skin.

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