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

He, Xiaofei; Schifferdecker, Karen E.; Ozanne, Elissa M.; Woloshin, Steven; Schwartz, Lisa M.

doi:10.1007/s11606-018-4601-9

Cited by 24 publications

(76 citation statements)

References 41 publications

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“…The theme “belief in science” also highlighted some women's skepticism about the accuracy of risk estimates and the rationale behind risk‐based screening, suspecting a financial motive. These concerns were previously mentioned by US women who professed a reluctance to change current screening habits, fearing missed breast cancers with a changed screening interval …”

Section: Discussionmentioning

confidence: 95%

“…However, knowledge of their risk did not lead to any consistent changes in screening or preventative behaviours . Additionally, although women generally appear in favor of increased screening for high‐risk women, lowering screening intensity for low‐risk women is more contested . Women are concerned about the accuracy of breast cancer risk estimates with some believing that risk‐based screening is mainly motivated by a desire to save money .…”

Section: Introductionmentioning

confidence: 99%

“…Additionally, although women generally appear in favor of increased screening for high‐risk women, lowering screening intensity for low‐risk women is more contested . Women are concerned about the accuracy of breast cancer risk estimates with some believing that risk‐based screening is mainly motivated by a desire to save money . Their perceptions of prevention also seem mixed .…”

Section: Introductionmentioning

confidence: 99%

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Women's perceptions of personalized risk‐based breast cancer screening and prevention: An international focus group study

Rainey¹,

et al. 2019

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Objective Increased knowledge of breast cancer risk factors enables a shift from one‐size‐fits‐all breast cancer screening to a risk‐based approach, tailoring screening policy to a woman's individual risk. New opportunities for prevention will arise. However, before this novel screening and prevention program is introduced, its acceptability from a woman's perspective needs to be explored. Methods Women eligible for breast cancer screening in the Netherlands, United Kingdom, and Sweden were invited to take part in focus groups. A total of 143 women participated. Data were transcribed verbatim and analyzed using thematic analysis. Results Analysis identified five themes across the three countries. The first theme “impact of knowledge” describes women's concern of not being able to unlearn their risk, perceiving it as either a motivator for change or a burden which may lead to stigma. The second theme “belief in science” explains women's need to trust the science behind the risk assessment and subsequent care pathways. Theme three “emotional impact” explores, eg, women's perceived anxiety and (false) reassurance, which may result from knowing their risk. Theme four “decision making” highlights cultural differences in shared versus individual decision making. Theme five “attitude to medication” explores the controversial topic of offering preventative medication for breast cancer risk reduction. Conclusions Acceptability of risk‐based screening and prevention is mixed. Women's perceptions are informed by a lack of knowledge, cultural norms, and common emotional concerns, which highlights the importance of tailored educational materials and risk counselling to aid either shared or individual informed decision making.

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Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Women's perceptions of personalized risk‐based breast cancer screening and prevention: An international focus group study

Rainey¹,

et al. 2019

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confidence: 99%

“…T his qualitative study investigates women's attitudes regarding the concept of risk-based breast cancer screening, or the process of tailoring screening recommendations based on a woman's breast cancer risk. 1 The authors conducted four focus groups with 29 women at which they presented women with a description of the risk-based screening paradigm and women discussed their impressions.…”

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confidence: 99%

Capsule Commentary on He et al., How Do Women View Risk-Based Mammography Screening? A Qualitative Study

Pace

2018

J GEN INTERN MED

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T his qualitative study investigates women's attitudes regarding the concept of risk-based breast cancer screening, or the process of tailoring screening recommendations based on a woman's breast cancer risk. 1 The authors conducted four focus groups with 29 women at which they presented women with a description of the risk-based screening paradigm and women discussed their impressions.Women expressed mixed feelings about a risk-based approach. Some women expressed confusion and skepticism about Btraditional^screening strategies, including questioning the motivations of providers and the health care system in the trend towards reduced screening. Although some women felt that a risk-based approach made sense, some were concerned about the possibility of under-screening and missed cancers, and some questioned the accuracy of risk models to predict an individual's risk.National screening guidelines have increasingly recommended an individualized approach to breast cancer screening. The increasing age thresholds for screening initiation recommended by major guidelines 2, 3 reflect the reality that older women are at higher risk of breast cancer, and higher-risk women face a more favorable ratio of benefits to harms from screening. However, how to operationalize risk-based screening in primary care settings remains unclear. 4 In addition to uncertainty about appropriate risk thresholds for screening strategies, and the limitations of existing risk models, a riskbased approach requires more patient and provider education, integration of risk assessment tools into practice, and more visit time.This article introduces some of the questions that many patients will have about this approach, and highlights the need for other areas of study. Understanding the perspectives of women with less education, and women of color, and developing appropriate educational tools will be critical, along with examining their implementation. Importantly, studies have suggested that high-quality decision aids can effectively help patients incorporate considerations of false positive results and overdiagnosis into their screening decisions. 5 The mistrust communicated by some patients in this study will require concerted efforts to address. Ultimately, however, risk-based screening represents an attempt to optimize patients' experiences and outcomes. This is a goal about which patients and providers should agree.

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Effect of Messaging on Support for Breast Cancer Screening Cessation Among Older US Women

Schoenborn,

Gollust,

Nagler

et al. 2024

JAMA Netw Open

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ImportanceMany older women are screened for breast cancer beyond guideline-recommended thresholds. Messaging holds promise to reduce overscreening.ObjectiveTo investigate the effect of a message on older women’s support for and intentions of stopping breast cancer screening.Design, Setting, and ParticipantsA 2-wave randomized clinical online survey trial using a nationally representative online panel was performed from May 12 to June 19, 2023. Women 65 years or older without breast cancer were eligible to participate.InterventionA pilot-tested breast cancer screening cessation message delivered to a hypothetical older woman with serious illnesses and functional impairment. The message was described as from 1 of 3 sources (clinician, news story, or family member). Participants were randomized into 4 groups: no message (group 1 [control]), a single message from a clinician at wave 1 and no message at wave 2 (group 2), a message from a news story (wave 1) and a clinician (wave 2) (group 3), and a message from a family member (wave 1) and a clinician (wave 2) (group 4).Main Outcomes and MeasuresSupport for stopping screening in the hypothetical older woman (primary) and screening intentions for oneself (secondary) were assessed on 7-point scales, with higher values indicating stronger support for and intentions to stop screening. Means were compared using analysis of variance. The message effect on screening intentions among participants 75 years or older and those with life expectancy of less than 10 years were also explored.ResultsA total of 3051 women participated in wave 1 of the trial. The mean (SD) age was 72.8 (5.9) years; 272 (8.9%) were non-Hispanic Black and 2506 (82.1%) were non-Hispanic White. Of these women, 2796 (91.6%) completed wave 2. Group 2 had significantly higher support for screening cessation in the hypothetical patient at wave 2 (mean score, 3.14 [95% CI, 2.99-3.29]) compared with group 1 (mean score, 2.68 [95% CI, 2.54-2.82]; P &lt; .001). The effect was even stronger in group 3 (mean score, 4.23 [95% CI, 4.09-4.38]) and group 4 (mean score, 4.12 [95% CI, 3.97-4.27]) compared with both groups 1 and 2 (all P &lt; .001). Message effects on self-screening intentions followed a similar pattern, with larger effects among participants 75 years or older or with limited life expectancy.Conclusions and RelevanceIn this randomized clinical trial, a breast cancer screening cessation message significantly increased older women’s support for and intentions of screening cessation. The strongest effects were observed when the message was delivered over time from multiple sources. Future work needs to engage potential message sources to examine the feasibility and acceptability of multilevel messaging strategies and their effect on screening behavior.Trial RegistrationClinicalTrials.gov Identifier: NCT05821023

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

Cited by 24 publications

References 41 publications

Women's perceptions of personalized risk‐based breast cancer screening and prevention: An international focus group study

Women's perceptions of personalized risk‐based breast cancer screening and prevention: An international focus group study

Capsule Commentary on He et al., How Do Women View Risk-Based Mammography Screening? A Qualitative Study

Effect of Messaging on Support for Breast Cancer Screening Cessation Among Older US Women

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