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Table 1.  
Awareness and Perceived Importance of Mammogram Benefits, Nationally Representative Sample of 407 Women Ages 40 to 59 Years
Awareness and Perceived Importance of Mammogram Benefits, Nationally Representative Sample of 407 Women Ages 40 to 59 Years
Table 2.  
Awareness and Perceived Importance of Mammogram Harms, Nationally Representative Sample of 407 Women Ages 40 to 59 Years
Awareness and Perceived Importance of Mammogram Harms, Nationally Representative Sample of 407 Women Ages 40 to 59 Years
1.
Pace  LE, Keating  NL.  A systematic assessment of benefits and risks to guide breast cancer screening decisions.  JAMA. 2014;311(13):1327-1335.PubMedGoogle ScholarCrossref
2.
Schwartz  LM, Woloshin  S, Fowler  FJ  Jr, Welch  HG.  Enthusiasm for cancer screening in the United States.  JAMA. 2004;291(1):71-78.PubMedGoogle ScholarCrossref
3.
Hoffmann  TC, Del Mar  C.  Patients’ expectations of the benefits and harms of treatments, screening, and tests: a systematic review.  JAMA Intern Med. 2015;175(2):274-286.PubMedGoogle ScholarCrossref
4.
Schwartz  LM, Woloshin  S, Sox  HC, Fischhoff  B, Welch  HG.  US women’s attitudes to false positive mammography results and detection of ductal carcinoma in situ: cross sectional survey.  BMJ. 2000;320(7250):1635-1640.PubMedGoogle ScholarCrossref
5.
Wegwarth  O, Gigerenzer  G.  Less is More: overdiagnosis and overtreatment: evaluation of what physicians tell their patients about screening harms.  JAMA Intern Med. 2013;173(22):2086-2087.PubMedGoogle ScholarCrossref
Research Letter
September 2017

Women’s Awareness and Perceived Importance of the Harms and Benefits of Mammography Screening: Results From a 2016 National Survey

Author Affiliations
  • 1Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis
  • 2School of Journalism and Mass Communication, University of Minnesota, Minneapolis
  • 3Government Department, Wesleyan University, Middletown, Connecticut
  • 4Department of Medicine, University of California-San Francisco, San Francisco
  • 5Department of Epidemiology/Biostatistics, University of California-San Francisco, San Francisco
  • 6Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis
JAMA Intern Med. 2017;177(9):1381-1382. doi:10.1001/jamainternmed.2017.2247

There is growing scientific consensus that mammography has a modest impact on averting deaths from breast cancer, while exposing women to a number of harms.1 Yet it is not well known how women in the general US public perceive the benefits and harms of mammography screening. Previous research has been published on public enthusiasm for screening and underestimates of harms, but these findings may be outdated.2-4 In this study, we present 2016 data on women’s awareness and perceptions of the benefits and harms of mammography, drawn from a larger survey of US adults on exposure to cancer-related information in the media.

Methods

Study participants were recruited by GfK, a survey research firm that maintains a probability-based panel of approximately 55 000 adults. GfK recruits panel participants through address-based probability sampling and provides small financial incentives to panel members for completing surveys. Among eligible panelists randomly selected to participate, 1519 (51%) completed the online survey between May 24 and June 6, 2016. Data reported herein are restricted to US women aged 40 to 59 years (n = 407) who received a stand-alone module about (1) awareness of the benefits/harms of mammograms, and (2) evaluations of the importance of these benefits/harms (Table 1 and Table 2). Both the question blocks, and the items within these blocks, were randomized. Prior to these items, respondents answered questions about their general and mammogram-related news and health media consumption. They also answered 2 items (“have you ever had a mammogram” and “when did you have your most recent mammogram to check for breast cancer”), which we used to construct 3 categories of mammogram history: (1) never had a mammogram, (2) had over a year ago, and (3) had less than a year ago. We tested for differences in importance evaluations by mammogram history using ordered logit regression. Analyses applied the GfK survey weights to adjust for nonresponse bias and panel nonresponse to produce nationally-representative estimates. The study was determined to be exempt from review by the University of Minnesota institutional review board.

Results

Fifty-eight (14.2%) participants reported never having a mammogram, 197 (56.4%) reported having a mammogram within the past year, and 103 (29.4%) reported having a mammogram less recently. Nearly all respondents (366, >90% for each) were aware of 4 statements describing mammography benefits (Table 1). When asked to rate their importance, most (223 [54.8]) concluded that each benefit was “very important.” Respondents’ awareness of harms, however, was much more variable (Table 2). Although only 108 (26.5%) reported prior awareness of overdiagnosis and 161 (39.7%) of overtreatment, 305 (74.9%) were aware of false-positive results and the potential of psychological distress. In contrast to their evaluations of benefits, fewer women rated harms as very important, ranging from 61 (15.1%) (health care system costs) to 117 (28.7%) (overtreatment). There were no statistically significant differences in awareness or ratings of importance by age group (40-49 years vs 50-59 years).

Women who reported having a mammogram within the past year were significantly more likely to rate all 4 benefits as very important, compared with those who who never had a mammogram (62.4%-74.9% vs 44.9%-58.0%; differences significant at P<.05). Women who reported having a mammogram within the past year were significantly less likely to rate health care system costs and radiation harms as very important compared with those who never had a mammogram (11.5% and 15.1% vs 22.9% and 25.7%; differences significant at P<.05).

Discussion

Women are more aware of the benefits of mammography screening than the harms, and women who have recently undergone mammography are more likely to judge these benefits as important. This may be owing to a lack of balanced information from physicians,5 public health officials, news media, and disease advocacy groups that have long emphasized screening’s benefits. Our findings suggest that there are opportunities for targeted education and communication at both the general public and individual levels, with a focus on educating women on the harms of screening, which they are much more likely to experience than benefits. However, the fact that women are predisposed to consider benefits as more important than harms poses a challenge to informed decision making about screening, suggesting the need for new paradigms in communicating the cumulative risks of the benefits and harms.

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Article Information

Corresponding Author: Jiani Yu, BA, Division of Health Policy and Management, School of Public Health, University of Minnesota, 420 Delaware St SE, A-367, Minneapolis, MN 55455 (yuxx0344@umn.edu).

Accepted for Publication: April 16, 2017.

Published Online: June 26, 2017. doi:10.1001/jamainternmed.2017.2247

Author Contributions: J. Yu had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Nagler, Fowler, Kerlikowske, Gollust.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Yu, Gollust.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Yu.

Obtained funding: Gollust.

Administrative, technical, or material support: Yu, Nagler.

Supervision: Kerlikowske, Gollust.

Conflict of Interest Disclosures: None reported.

Funding/Support: This research was supported by the American Cancer Society, through a Research Scholar Grant, RSG-14-166-01-CPPB. Rebekah H. Nagler also acknowledges support from the Building Interdisciplinary Research Careers in Women’s Health Grant (K12-HD055887) from the Eunice Kennedy Shriver National Institutes of Child Health and Human Development, the Office of Research on Women’s Health, and the National Institute on Aging, administered by the University of Minnesota Deborah E. Powell Center for Women’s Health.

Role of the Funder/Sponsor: The funding sources had no role in the design or conduct of the study, the collection and analysis of the data, or the approval and decision to submit the manuscript for publication.

Meeting Presentation: This paper was presented at the AcademyHealth 2017 Annual Research Meeting; June 26, 2017; New Orleans, Louisiana.

References
1.
Pace  LE, Keating  NL.  A systematic assessment of benefits and risks to guide breast cancer screening decisions.  JAMA. 2014;311(13):1327-1335.PubMedGoogle ScholarCrossref
2.
Schwartz  LM, Woloshin  S, Fowler  FJ  Jr, Welch  HG.  Enthusiasm for cancer screening in the United States.  JAMA. 2004;291(1):71-78.PubMedGoogle ScholarCrossref
3.
Hoffmann  TC, Del Mar  C.  Patients’ expectations of the benefits and harms of treatments, screening, and tests: a systematic review.  JAMA Intern Med. 2015;175(2):274-286.PubMedGoogle ScholarCrossref
4.
Schwartz  LM, Woloshin  S, Sox  HC, Fischhoff  B, Welch  HG.  US women’s attitudes to false positive mammography results and detection of ductal carcinoma in situ: cross sectional survey.  BMJ. 2000;320(7250):1635-1640.PubMedGoogle ScholarCrossref
5.
Wegwarth  O, Gigerenzer  G.  Less is More: overdiagnosis and overtreatment: evaluation of what physicians tell their patients about screening harms.  JAMA Intern Med. 2013;173(22):2086-2087.PubMedGoogle ScholarCrossref
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