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Dr. Jefford makes some important points in his letter. The reasons women are not undertaking routine mammography screening probably are complex. Knowledge, attitudes, and belief systems appear to be influential, as he notes. However, the data on anxiety, fear, and misperceptions about risk are not as clear. In an earlier study of 650 women,1 we observed no differences in perceived versus actual risk factors or in psychological profiles (using several measures) between adhering women and nonadhering women. Women who did not adhere had a statistically higher body mass index than women who did adhere (27.6 kg/m2 vs. 26.1 kg/m2; P = .003). In an exploration of mammographic experiences by group, we found that care taken by technologists in performing or talking women through the examination was greater in adhering women than in nonadhering women (75.6% vs. 65.71% for performing the examination and 71.6% vs. 60.8% for talking patients through the examination, respectively; P<.05). More research should be conducted with mammography technologists, who are likely to be the only healthcare professionals who have direct contact with women undergoing mammography, to address knowledge and attitudes barriers and to ensure that women have as positive a mammography experience as possible. Research also is needed to reach women who have never had a mammogram to gain a better understanding of their barriers to mammography screening.

Patricia A. Carney PhD*, * Department of Community and Family Medicine, Dartmouth Medical School, Lebanon, New Hampshire.

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