Decision making and counseling around mammography screening for women aged 80 or older

Schonberg, Mara A.; Ramanan, Radhika A.; McCarthy, Ellen P.; Marcantonio, Edward R.

doi:10.1007/bf02743148

Cited by 63 publications

(82 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…21 To better understand older women’s decision-making and informational needs around mammography, we previously conducted a qualitative study. 13 Since the current cohort of women ≥75 years tends to have low computer literacy, 22 we chose a pamphlet format.…”

Section: Methodsmentioning

confidence: 99%

Development and Evaluation of a Decision Aid on Mammography Screening for Women 75 Years and Older

et al. 2014

Self Cite

View full text Add to dashboard Cite

IMPORTANCE Guidelines recommend that women 75 years and older should be informed of the benefits and risks of mammography before being screened. However, few are adequately informed.OBJECTIVES To develop and evaluate a mammography screening decision aid (DA) for women 75 years and older.DESIGN We designed the DA using international standards. Between July 14, 2010, and April 10, 2012, participants completed a pretest survey and read the DA before an appointment with their primary care physician. They completed a posttest survey after their appointment. Medical records were reviewed for follow-up information.SETTING AND PARTICIPANTS Boston, Massachusetts, academic primary care practice. Eligible women were aged 75 to 89 years, English speaking, had not had a mammogram in 9 months but had been screened within the past 3 years, and did not have a history of dementia or invasive or noninvasive breast cancer. Of 84 women approached, 27 declined to participate, 12 were unable to complete the study for logistical reasons, and 45 participated.INTERVENTIONS The DA includes information on breast cancer risk, life expectancy, competing mortality risks, possible outcomes of screening, and a values clarification exercise.MAIN OUTCOMES AND MEASURES Knowledge of the benefits and risks of screening, decisional conflict, and screening intentions; documentation in the medical record of a discussion of the risks and benefits of mammography with a primary care physician within 6 months; and the receipt of screening within 15 months. We used the Wilcoxon signed rank test and McNemar test to compare pretest-posttest information. RESULTSThe median age of participants was 79 years, 69% (31 of 45) were of non-Hispanic white race/ethnicity, and 60% (27 of 45) had attended at least some college. Comparison of posttest results with pretest results demonstrated 2 findings. First, knowledge of the benefits and risks of screening improved (P < .001). Second, fewer participants intended to be screened (56% [25 of 45] afterward compared with 82% [37 of 45] before, P = .03). Decisional conflict declined but not significantly (P = .10). In the following 6 months, 53% (24 of 45) of participants had a primary care physician note that documented the discussion of the risks and benefits of screening compared with 11% (5 of 45) in the previous 5 years (P < .001). While 84% (36 of 43) had been screened within 2 years of participating, 60% (26 of 43) were screened within 15 months after participating (Ն2 years since their last mammogram) (P = .01). Overall, 93% (42 of 45) found the DA helpful.CONCLUSIONS AND RELEVANCE A DA may improve older women's decision making about mammography screening.

show abstract

Section: Methodsmentioning

confidence: 99%

Development and Evaluation of a Decision Aid on Mammography Screening for Women 75 Years and Older

et al. 2014

Self Cite

View full text Add to dashboard Cite

show abstract

“…2 In the last decades there is little increasing of knowledge and development of breast cancer management, which resulted in little decrease of mortality rates from breast cancer. 3,4 All women are at risk for developing breast cancer. A woman's chance of developing invasive breast cancer at some time in her life is approximately 1 in 8 (12%).…”

mentioning

confidence: 99%

“…Mammography and sonomammography are the standard imaging techniques for detection and evaluation of breast disease. 3,4 Mammography has been the "gold standard" in breast cancer screening and detection for more than 40 years. However, mammography is known toa have a certain false-negative rates.…”

mentioning

confidence: 99%

Significance of Quadruple assessment of breast lump–A hospital based study

Ghartimagar

Ghosh

et al. 2014

J Pathol Nep

View full text Add to dashboard Cite

Background: Approximately 10% of breast masses are breast cancer. It is important for women with a breast lump to receive appropriate evaluation. Mammography has been the "gold standard" in breast cancer detection for >40 years. Ultrasonography is non-invasive easily available, cheaper and accurate tool while Fine needle aspiration cytology has a high diagnostic accuracy rate in hands of experienced cytopathologist. Materials and methods:This was a retrospective and prospective study of 173 women attending radiology department in Manipal Teaching Hospital, Pokhara for mammography during a period of 18 months from January 2011 to June 2012.The age ranged from 20yrs to 75yrs. BIRADS score was given for both mammography and sonomammography. All malignant and suspicious cases had undergone fine needle aspiration cytology. Cytology reports were correlated with imaging study. Results:The most common age group for the breast lump was 40-49 years showing 65(37.57%) cases. Most lumps were seen on the left side 54.3% (94/ 173) cases and were seenin upper outer quadrant of the breast (74 cases). 11 cases each were given the BIRADS score of 4 in both mammography and sonomammography. Sensitivity and specificity of mammography and sonomammography were compared to cytologyreports. The sensitivity for mammogram was 73.7% while specificity was 96.3%. The sensitivity and specificity for sonomammogram was 78.9% and 95% respectively. Conclusion:Quadruple assessment i.e. clinical assessment, mammography, sonomammography and cytologicalstudy are the new "gold standard" in the investigation of breast disease.

show abstract

“…The population of women over age 75 is rising rapidly and increasingly these women are being screened with mammography without a balanced discussion of the potential benefits and harms [1-3,24,29]. Some experts consider it a medical error if a patient undergoes a test that they would not have chosen if they had a better understanding of the likely outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Guidelines encourage clinicians to discuss the uncertainty about the balance of benefits and harms with older women [7,8,22]. Yet, few older women are informed of potential harms of mammography before being screened, likely because explaining such uncertainty can be challenging and time consuming [3,23,24]. As a result 56% of women >75 years are screened, including 50% of women with <10 year life expectancy - an estimated 2.8 million US women [25].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of a Mammography Screening Decision Aid for Women Aged 75 and Older: Protocol for a Cluster-randomized Controlled Trial

et al. 2015

View full text Add to dashboard Cite

Purpose There is insufficient evidence to recommend mammography for women >75 years. Guidelines recommend that older women be informed of the uncertainty of benefit and potential for harm, especially for women with short life expectancy. However, few older women are informed of harms of screening and many with short life expectancy are screened. Therefore, we aim to test whether a mammography screening decision aid (DA) for women >75 years affects their use of mammography, particularly for women with <10 year life expectancy. Methods/Design The DA is a self-administered pamphlet that includes information on screening outcomes, tailored information on breast cancer risk, health, life expectancy, and competing mortality risks, and includes a values clarification exercise. We are conducting a large cluster randomized controlled trial (RCT) of the DA with the primary care provider (PCP) as the unit of randomization to evaluate its efficacy. We plan to recruit 550 women 75-89 years from 100 PCPs to receive either the mammography DA or a pamphlet on home safety for older adults (control arm) before a visit with their PCP, depending on their PCP's randomization assignment. The primary outcome is receipt of mammography screening assessed through chart abstraction. Secondary outcomes include effect of the DA on older women's screening intentions, knowledge, and decisional conflict, and on documented discussions about mammography by their PCPs. We will recruit women from 5 Boston-based primary care practices (3 community-based internal medicine practices and 2 academic practices), and 2 North Carolina-based academic primary care practices. Discussion It is essential that we test the DA in a large RCT to determine if it is efficacious and to substantiate the need for broad translation into clinical practice. Our DA has the potential to improve health care utilization and care in a manner dictated by patient preferences.

show abstract

Decision making and counseling around mammography screening for women aged 80 or older

Cited by 63 publications

References 35 publications

Development and Evaluation of a Decision Aid on Mammography Screening for Women 75 Years and Older

Development and Evaluation of a Decision Aid on Mammography Screening for Women 75 Years and Older

Significance of Quadruple assessment of breast lump–A hospital based study

Evaluation of a Mammography Screening Decision Aid for Women Aged 75 and Older: Protocol for a Cluster-randomized Controlled Trial

Contact Info

Product

Resources

About