Systematic review on women's values and preferences concerning breast cancer screening and diagnostic services

Abstract

Background There is still lack of consensus on the benefit‐harm balance of breast cancer screening. In this scenario, women's values and preferences are crucial for developing health‐related recommendations. In the context of the European Commission Initiative on Breast Cancer, we conducted a systematic review to inform the European Breast Guidelines. Methods We searched Medline and included primary studies assessing women's values and preferences regarding breast cancer screening and diagnosis decision making. We used a thematic approach to synthesise relevant data. The quality of evidence was determined with GRADE, including GRADE CERQual for qualitative research. Results We included 22 individual studies. Women were willing to accept the psychological and physical burden of breast cancer screening and a significant risk of overdiagnosis and false‐positive mammography findings, in return for the benefit of earlier diagnosis. The anxiety engendered by the delay in getting results of diagnostic tests was highlighted as a significant burden, emphasising the need for rapid and efficient screening services, and clear and efficient communication. The confidence in the findings was low to moderate for screening and moderate for diagnosis, predominantly because of methodological limitations, lack of adequate understanding of the outcomes by participants, and indirectness. Conclusions Women value more the possibility of an earlier diagnosis over the risks of a false‐positive result or overdiagnosis. Concerns remain that women may not understand the concept of overdiagnosis. Women highly value time efficient screening processes and rapid result delivery and will accept some discomfort for the peace of mind screening may provide.

Systematic reviews as a “lens of evidence”: Determinants of participation in breast cancer screening

“…18,22 Nevertheless, the reviews agreed that untargeted mass invitations (including social networks and mass media) had no effect on screening participation, 13,20,34 while recommendations from healthcare providers were important. 14,19,35 [14][15][16]36 Situational factors/cues to action Risk-factor questionnaires No or limited effect Two reviews 14,26 Fixed appointment with any invitation approach Positive Four reviews 13,14,18,22 Reminder letters or invitation follow-ups Positive Eight reviews 8,13,14,18,19,22,28 Regarding education-related interventions, the reviews based on both trials and observational evidence showed a positive impact of telephone counselling, 8,14,28,29 face-toface counselling, 18,20,22,28 and educational home visits 14,29 on uptake of screening mammography. However, the last two types of intervention were non-superior to simple calls or letters.…”

Experiences of Patients Undergoing Bowel Preparation and Colonoscopy- A Qualitative Longitudinal Study

“…These challenges have even shown to exist in patients who have experienced multiple colonoscopies (33). Although planning in everyday life due to participation have also shown to be challenging in other screening settings like breast cancer screening (34,35), preparation for colonoscopy have shown to interfere with everyday activities for a longer period.…”

Supplemental screening using breast MRI in women with mammographically dense breasts

“…Image-guided biopsies are considered safe irrespective of the method used. Proven is a certain psychological harm in terms of increased anxiety and associated symptoms [24]. Despite this, psychooncological research data demonstrate that women are actually willing to accept both the direct harms by recalls and unnecessary biopsies and the possibility of overdiagnosis for the prospect of an earlier diagnosis [24].…”

“…In case of doubt, we should consider the opinion of those affected. Eligible women themselves, being those that are subject to both risks and benefits, generally are in favour of screening despite acknowledging the risk [24]. While one could argue that the concept of overdiagnosis is difficult to convey on an individual level and that it is limited understanding of the associated risks that brings women to support screening, such arguments are elitist in nature and deeper discussed in the context of democracy in [32].…”