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

• Published in: Journal of general internal medicine : JGIM Vol. 33; no. 11; pp. 1905 - 1912
• Main Authors: He, Xiaofei, Schifferdecker, Karen E., Ozanne, Elissa M., Tosteson, Anna N. A., Woloshin, Steven, Schwartz, Lisa M.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.11.2018; Springer Nature B.V
• Subjects: Acceptability; Adult; Aged; Breast cancer; Breast Neoplasms - diagnostic imaging; Breast Neoplasms - psychology; Cancer; Cervical cancer; Cervix; Content analysis; Early Detection of Cancer - methods; Early Detection of Cancer - psychology; False Positive Reactions; Feasibility; Feasibility studies; Female; Focus Groups - methods; Health care; Health risk assessment; Health risks; Humans; Internal Medicine; Mammography; Mammography - methods; Mammography - psychology; Medical diagnosis; Medical Overuse - prevention & control; Medicine; Medicine & Public Health; Messages; Middle Aged; Original Research; Qualitative Research; Risk analysis; Screening; Womens health; health communication; risk-based screening mammography; over-diagnosis
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1007/s11606-018-4601-9

Background Decades of persuasive messages have reinforced the importance of traditional screening mammography at regular intervals. A potential new paradigm, risk-based screening, adjusts mammography frequency based on a woman’s estimated breast cancer risk in order to maximize mortality reduction while minimizing false positives and overdiagnosis. Women’s views of risk-based screening are unknown. Objective To explore women’s views and personal acceptability of a potential risk-based mammography screening paradigm. Design Four semi-structured focus group discussions about screening mammography and surveys before provision of information about risk-based screening. We analyzed coded focus group transcripts using a mixed deductive (content analysis) and inductive (grounded theory) approach. Participants Convenience sample of 29 women (40–74 years old) with no personal history of breast cancer recruited by print and online media in New Hampshire and Vermont. Results Twenty-seven out of 29 women reported having undergone mammography screening. All participants were white and most were highly educated. Some women accepted the idea that early cancer detection with traditional screening was beneficial—although many also reported hearing inconsistent recommendations from clinicians and mixed messages from media reports about mammography. Some women were familiar with a risk-based screening paradigm (primarily related to cervical cancer, n  = 8) and thought matching screening mammography frequency to personal risk made sense ( n  = 8). Personal acceptability of risk-based screening was mixed. Some believed risk-based screening could reduce the harms of false positives and overdiagnosis ( n  = 7). Others thought screening less often might result in missing a dangerous diagnosis ( n  = 14). Many ( n  = 18) expressed concerns about the feasibility of risk-based screening and questioned whether breast cancer risk estimates could be accurate. Some suspected that risk-based mammography was motivated by a desire to save money ( n  = 6). Conclusion Some women thought risk-based screening made sense. Willingness to abandon traditional screening for the new paradigm was mixed. Broad acceptability of risk-based screening will require clearer communication about its rationale and feasibility and consistent messages from the health care team.