Women’s Awareness of and Responses to Messages About Breast Cancer Overdiagnosis and Overtreatment

Abstract

Background Scientists, clinicians, and other experts aim to maximize the benefits of cancer screening while minimizing its harms. Chief among these harms are overdiagnosis and overtreatment. Although available data suggest that patient awareness of these harms is low, we know little about how patients respond to information about these phenomena. Objectives Using the case of breast cancer screening, this study assesses women’s awareness of and reactions to statements about overdiagnosis and overtreatment. Methods We draw on data from a 2016 population-based survey of U.S. women aged 35–55 years that oversampled women of lower socioeconomic position (those living at or below 100% of federal poverty level) (N=429). Results Results showed that women’s awareness of overdiagnosis (16.5%) and overtreatment (18.0%) was low, and women under age 40 were least likely to have heard about overdiagnosis. Most women did not evaluate statements about these harms positively: Fewer than 1 in 4 agreed with and found statements about overdiagnosis and overtreatment to be believable, and even fewer evaluated them as strong arguments to consider in their own mammography decision making. Women with a recent mammogram history were particularly unconvinced by overdiagnosis and overtreatment arguments. Conclusions A majority of women were unaware of two important harms of breast cancer screening: overdiagnosis and overtreatment. Most did not find statements about these harms to be believable and persuasive. Communication interventions, supported by evidence from health communication research, are necessary to improve patient understanding of screening’s harms, promote informed decision making, and, in turn, ensure high value care.

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

“…Our findings are consistent with prior qualitative studies and surveys which found that USPSTF's updated mammography guidelines recommending less screening had limited impact on women's screening decisions 26,27 and that women's familiarity with the concept of overdiagnosis was limited. [27][28][29] Our findings were also consistent with prior work finding that women feared underdiagnosis more than overdiagnosis, were suspicious of the underlying reasons for guideline changes, and viewed routine screening as a personal obligation. 30,31 Prior work also shows that women experienced cognitive dissonance when presented with evidence-based mammography information that conflicted with their pre-existing beliefs.…”

Integration of genetic and metabolic features related to sialic acid metabolism distinguishes human breast cell subtypes

“…The ability of the ‘high flux’ ManNAc analogs to illuminate otherwise hidden metabolic features of human breast cell subtypes based on the slight chemical changes present at their N-acyl groups (e.g., ‘NAc’ vs ‘NAz’ vs ‘NAl’; Fig 1 ) raises the possibility that this class of compounds could be exploited for the detection or diagnosis of cancer. (The need for improved diagnostic approaches for breast cancer is based in part on the current over-diagnosis and over-treatment of this disease [ 87 , 88 ]). By using metabolic metrics including the capacity for sialic acid biosynthesis, which we showed can discriminate cell lines representing different stages of cancer progression using a multiple regression model, we propose that diagnostic precision can be improved if metabolic characteristics related to sialic acid biosynthesis explored in this report hold broadly across normal, earlier, and later stage cancer.…”

Influence of Income on Cancer Incidence and Death among Patients in Aomori, Japan

“…Second, because there were no significant differences in adjusted HRs according to age, overdiagnosis due to easy access to hospitals would increase the incidence rates and overtreatment for patients with breast, cervical, and prostate cancers simultaneously in higher-income areas. Several studies have underlined the problems of overdiagnosis and overtreatment (Nagler et al, 2017;Morgan et al, 2017;Jegerlehner et al, 2017). The Norwegian Breast Cancer Screening Program was conducted in 1995 and 1996 (Falk et al, 2013).…”