Overscreening for Women’s Cancer: Time for Change

Beyond Access: Prioritizing Equity during Discussions about Cancer Screening

“…The current state of SDM for breast cancer screening is not sufficient for changing how we approach screening in light of the harms patients may face from overscreening. As Dr. Marx shares, “Indeed, it was not until I consulted a gynecologist at a top teaching hospital that I was able to discuss my past overscreening and evidence-driven choices, with sharp decreases in screening moving forward.” 1 Exclusive access to SDM at top teaching hospitals limits access and equitable opportunities for informed choice. Equity needs to be prioritized at each level for implementing the supports needed to actually inform patients of the benefits and harms of screening.…”

“…Dr. Rani Marx describes her lived experience navigating the cancer screening process with questions about how to weigh benefits and harms. 1 This poignant example outlines how even those who are well equipped to make informed choices are met with a variety of barriers to shared decision making (SDM) that can expose people to unnecessary physical, psychological, and financial harms of cancer screening. 2 While these harms are detrimental to all patients, it is particularly important to consider how these barriers to informed choice can exacerbate health disparities.…”

“…3–6 Few tools to support these exchanges are tested specifically with those from socially marginalized populations despite their potential to improve decisions. 7 Building on the barriers to informed choice outlined by Dr. Marx, including outdated screening information, limited SDM opportunities, and feeling the need to justify screening decisions, 1 breast cancer screening can provide an example for how we can consider equitable opportunities for informed decision making and avoid disproportionately exposing those in socially marginalized positions to additional harms.…”