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Journal of General Internal Medicine

, Volume 33, Issue 11, pp 1905–1912 | Cite as

How Do Women View Risk-Based Mammography Screening? A Qualitative Study

  • Xiaofei He
  • Karen E. Schifferdecker
  • Elissa M. Ozanne
  • Anna N. A. Tosteson
  • Steven Woloshin
  • Lisa M. Schwartz
Original Research

Abstract

Background

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.

Objective

To explore women’s views and personal acceptability of a potential risk-based mammography screening paradigm.

Design

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.

Participants

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.

Results

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).

Conclusion

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 WORDS

risk-based screening mammography over-diagnosis health communication 

Notes

Acknowledgements

We also wish to express our gratitude to the focus group participants who shared their valuable insights and experiences.

Funding

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.

Supplementary material

11606_2018_4601_MOESM1_ESM.docx (29 kb)
ESM 1 (DOCX 28 kb)

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Copyright information

© Society of General Internal Medicine 2018

Authors and Affiliations

  • Xiaofei He
    • 1
  • Karen E. Schifferdecker
    • 1
    • 2
  • Elissa M. Ozanne
    • 3
  • Anna N. A. Tosteson
    • 1
    • 4
  • Steven Woloshin
    • 1
    • 2
    • 4
  • Lisa M. Schwartz
    • 1
    • 2
    • 4
  1. 1.Geisel School of Medicine at DartmouthThe Dartmouth Institute for Health Policy and Clinical PracticeLebanonUSA
  2. 2.Department of Community and Family MedicineGeisel School of Medicine at DartmouthLebanonUSA
  3. 3.Department of Population Health SciencesUniversity of UtahSalt Lake CityUSA
  4. 4.Dartmouth-Hitchcock Norris Cotton Cancer CenterLebanonUSA

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