Older Women’s Perspectives Driving Mammography Screening Use and Overuse: a Narrative Review of Mixed-Methods Studies

Abstract

Purpose of Review Examining what older women know and perceive about mammography screening is critical for understanding patterns of under- and overuse, and concordance with screening mammography guidelines in the USA. This narrative review synthesizes qualitative and quantitative evidence around older women’s perspectives toward mammography screening. Recent Findings The majority of 43 identified studies focused on promoting mammography screening in women of different ages, with only four studies focusing on the overuse of mammography in women ≥ 70 years old. Older women hold positive attitudes around screening, perceive breast cancer as serious, believe the benefits outweigh the barriers, and are worried about undergoing treatment if diagnosed. Older women have limited knowledge of screening guidelines and potential harms of screening. Summary Efforts to address inequities in mammography access and underuse need to be supplemented by epidemiologic and interventional studies using mixed-methods approaches to improve awareness of benefits and harms of mammography screening in older racially and ethnically diverse women. As uncertainty around how best to approach mammography screening in older women remains, understanding women’s perspectives along with healthcare provider and system-level factors is critical for ensuring appropriate and equitable mammography screening use in older women.

A mixed-methods study of multi-level factors influencing mammography overuse among an older ethnically diverse screening population: implications for de-implementation

“…Findings from this study support that de-implementation likely works differently than implementation processes and is challenging because it works against prevailing practices and beliefs that reinforce the importance of mammography screening [ 1 , 43 ]. Similar to other studies, older women in our sample hold strong intentions to continue annual mammography screening [ 29 , 44 , 45 ]. Intention has shown to be a strong predictor of mammography screening cessation [ 46 ] and should be examined in light of factors that act as barriers and facilitators of mammography screening [ 47 ].…”

“…These findings support the broader notion that racial/ethnic minority populations are also susceptible to overuse that is perpetuated by providers and the operations of the system [ 36 , 56 , 57 ]. To date, few studies on de-implementation capture the perspectives and experiences of ethnically diverse populations or of older women more broadly [ 29 ]. In fact, a recent scoping review of de-implementation science theories, models, and frameworks found only two that account for the role of patients [ 57 ].…”

“…While prior studies have explored factors promoting mammography utilization and adherence, factors contributing to mammography overuse among older women in the USA remains limited and largely unknown [ 26 – 28 ]. A recent narrative review of older women’s perspectives around mammography screening found that older women are largely uninformed about cancer screening guidelines and the potential harms of mammography screening [ 29 ]. Other studies also report that most healthcare providers do not discuss the uncertain balance of mammography benefits and harms, and over 70% recommend mammography screening to their older patients [ 30 – 32 ].…”

“…Among the most critical next steps is ensuring that de-implementation efforts are equitable [ 33 – 35 ]. To date, few studies have included the perspectives of older, racial/ethnic minority women around mammography screening [ 29 ]. Understanding the perspectives and experiences of these populations is critical for ensuring de-implementation efforts do not further exacerbate existing cancer health disparities [ 34 , 36 ].…”

“It's something I'll do until I die”: A qualitative examination into why older women in the U.S. continue screening mammography

“…17,18 Limited available research suggests that screening mammography among older women may be habitual and perceived as reassuring and easily accessible. 12,15,[19][20][21] However, very little is known about older women's perspectives and experiences with regard to reducing or stopping mammography, particularly among racial or ethnic minority women in the US or samples from racially and ethnically diverse populations. 21 To address this gap, this study seeks to provide an in-depth understanding of the perspectives and preferences of older, ethnically diverse women as they relate to continued screening and potential overuse of routine breast cancer screening.…”