How Do Women View Risk-Based Mammography Screening? A Qualitative Study
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Decades of persuasive messages have reinforced the importance of traditional screening mammography at regular intervals. A potential new paradigm, risk-based screening, adjusts mammography frequency based on a woman’s estimated breast cancer risk in order to maximize mortality reduction while minimizing false positives and overdiagnosis. Women’s views of risk-based screening are unknown.
To explore women’s views and personal acceptability of a potential risk-based mammography screening paradigm.
Four semi-structured focus group discussions about screening mammography and surveys before provision of information about risk-based screening. We analyzed coded focus group transcripts using a mixed deductive (content analysis) and inductive (grounded theory) approach.
Convenience sample of 29 women (40–74 years old) with no personal history of breast cancer recruited by print and online media in New Hampshire and Vermont.
Twenty-seven out of 29 women reported having undergone mammography screening. All participants were white and most were highly educated. Some women accepted the idea that early cancer detection with traditional screening was beneficial—although many also reported hearing inconsistent recommendations from clinicians and mixed messages from media reports about mammography. Some women were familiar with a risk-based screening paradigm (primarily related to cervical cancer, n = 8) and thought matching screening mammography frequency to personal risk made sense (n = 8). Personal acceptability of risk-based screening was mixed. Some believed risk-based screening could reduce the harms of false positives and overdiagnosis (n = 7). Others thought screening less often might result in missing a dangerous diagnosis (n = 14). Many (n = 18) expressed concerns about the feasibility of risk-based screening and questioned whether breast cancer risk estimates could be accurate. Some suspected that risk-based mammography was motivated by a desire to save money (n = 6).
Some women thought risk-based screening made sense. Willingness to abandon traditional screening for the new paradigm was mixed. Broad acceptability of risk-based screening will require clearer communication about its rationale and feasibility and consistent messages from the health care team.
KEY WORDSrisk-based screening mammography over-diagnosis health communication
We also wish to express our gratitude to the focus group participants who shared their valuable insights and experiences.
This study was supported in part by funding from the National Cancer Institute (R25CA134286, P01CA154292, and P30CA023108).
Compliance with ethical standards
All study materials and procedures were approved by the Committee for the Protection of Human Subjects at Dartmouth College.
Conflicts of interest
Drs. Schwartz and Woloshin have served as medical experts in testosterone litigation and were the cofounders of Informulary, Inc., a company that provided data about the benefits and harms of prescription drugs, which ceased operations in December 2016. Other authors declare no conflicts of interest.
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