Enthusiasm for Cancer Screening in the United States

Abstract

Context Public health officials, physicians, and disease advocacy groups have worked hard to educate individuals living in the United States about the importance of cancer screening. Objective To determine the public's enthusiasm for early cancer detection. Design, Setting, and Participants Survey using a national telephone interview of adults selected by random digit dialing, conducted from December 2001 through July 2002. Five hundred individuals participated (women aged Ն40 years and men aged Ն50 years; without a history of cancer). Main Outcome Measures Responses to a survey with 5 modules: a general screening module (eg, value of early detection, total-body computed tomography); and 4 screening test modules: Papanicolaou test; mammography; prostate-specific antigen (PSA) test; and sigmoidoscopy or colonoscopy. Results Most adults (87%) believe routine cancer screening is almost always a good idea and that finding cancer early saves lives (74% said most or all the time). Less than one third believe that there will be a time when they will stop undergoing routine screening. A substantial proportion believe that an 80-year-old who chose not to be tested was irresponsible: ranging from 41% with regard to mammography to 32% for colonoscopy. Thirty-eight percent of respondents had experienced at least 1 falsepositive screening test; more than 40% of these individuals characterized that experience as "very scary" or the "scariest time of my life." Yet, looking back, 98% were glad they had had the initial screening test. Most had a strong desire to know about the presence of cancer regardless of its implications: two thirds said they would want to be tested for cancer even if nothing could be done; and 56% said they would want to be tested for what is sometimes termed pseudodisease (cancers growing so slowly that they would never cause problems during the persons lifetime even if untreated). Seventy-three percent of respondents would prefer to receive a total-body computed tomographic scan instead of receiving $1000 in cash. Conclusions The public is enthusiastic about cancer screening. This commitment is not dampened by false-positive test results or the possibility that testing could lead to unnecessary treatment. This enthusiasm creates an environment ripe for the premature diffusion of technologies such as total-body computed tomographic scanning, placing the public at risk of overtesting and overtreatment.

Use of a decision aid including information on overdetection to support informed choice about breast cancer screening: a randomised controlled trial

“…Although the absolute rate of informed choice appears low, against this background we believe the understanding participants demonstrated after a one-off booklet indicates success in communicating complex information about overdetection and other screening outcomes. Widespread public enthusiasm for cancer screening 36,37 can cause resistance to information about harms 38 which have not been well communicated in the past. 39 Mass health education or social marketing campaigns would never rely solely on a single small booklet to ensure effective communication of new information to the public.…”

Public views on participating in newborn screening using genome sequencing

“…The reduction in expected participation and perceived parental responsibility was driven by scepticism towards science as well as an understanding of NBS and its effects. These findings are striking given the enthusiasm for science and technology among our respondents, the general public's enthusiasm for screening 28 and their tendency to 'buy into' the messages emanating from scientists, media and commercial interests 'hyping' the promises of science and genomics. 36 Indeed, such enthusiasm was demonstrated in a recent study that reported parental interest in WG/ES-based NBS, based on the perception that WG/ES-based screening would be more accurate.…”

“…We asked respondents about their views on parental responsibility to participate in targeted NBS using current technologies and untargeted WG/ES. We adapted a measure of personal responsibility to participate in screening from the cancer context, 28 focusing on parental responsibility, which is appropriate to the infant screening setting. Respondents were asked to choose 'yes' or 'no' to the following question for each technology: 'Would you consider other parents irresponsible if they refused to participate in this type of newborn screening program?'…”

“…Attitudes towards science, technology, health care and understanding of NBS. We assessed attitudes towards science, technology and health care based on modified items from the literature 28,29,31 and their understanding of NBS using newly developed items (Table 2). Individuals reported their prior awareness of NBS.…”

“…The questionnaire included background information on the principles of screening and the varied effects of NBS (for example, early diagnosis and treatment, reproductive-risk information, false-positive results and overdiagnosis) followed by quizzes, a discrete choice experiment and a reasoning exercise. The questionnaire was developed by a multidisciplinary team on the basis of our preceding qualitative studies 19,25 and a review of the literature, [26][27][28][29][30][31] and was pretested through face-to-face cognitive interviews (over three rounds with n ¼ 16) and piloted with members of the internet panel (n ¼ 87) to assess comprehension, face and content validity.…”