Women’s Acceptance of Overdetection in Breast Cancer Screening: Can We Assess Harm-Benefit Tradeoffs?

Anne Stiggelbout, Tessa Copp, Gemma Jacklyn, Jesse Jansen, Gerrit-Jan Liefers, Kirsten McCaffery and Jolyn Hersch
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Anne Stiggelbout: Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Zuid-Holland, the Netherlands
Tessa Copp: Wiser Healthcare, Sydney School of Public Health, University of Sydney, New South Wales, Australia
Gemma Jacklyn: Wiser Healthcare, Sydney School of Public Health, University of Sydney, New South Wales, Australia
Jesse Jansen: Wiser Healthcare, Sydney School of Public Health, University of Sydney, New South Wales, Australia
Gerrit-Jan Liefers: Department of Surgery, Leiden University Medical Center, Leiden, Zuid-Holland, the Netherlands
Kirsten McCaffery: Wiser Healthcare, Sydney School of Public Health, University of Sydney, New South Wales, Australia
Jolyn Hersch: Wiser Healthcare, Sydney School of Public Health, University of Sydney, New South Wales, Australia

Medical Decision Making, 2020, vol. 40, issue 1, 42-51

Abstract: Background. Breast cancer screening has been presented to women as mostly positive for decades, despite voices raising issues related to harms since its introduction. Public communications about breast cancer screening tended to use persuasive techniques aimed at maximizing uptake. Concern about the harm of overdetection is more recent, and awareness of overdetection among the public is limited. We aimed to assess the impact of extensive information on treatment following overdetection in breast screening on women’s acceptance of screening, and to assess correlates of acceptance. Methods. We performed an online survey among women aged 45-75 from the general public in the Netherlands and Australia, asking women their maximum acceptable ratio of overdetection, per breast cancer death avoided, for four treatment scenarios (randomized order): mastectomy; lumpectomy; lumpectomy plus radiotherapy; lumpectomy plus radiotherapy and hormone therapy. The effect of treatment was assessed using General Linear Models, controlling for socio-demographics, experience, and psychological characteristics. Results. Four-hundred Australian and 403 Dutch women responded. Around half of the women would always screen, even at a 6:1 overdetection-to-death-avoided ratio. Acceptance was highest for the lumpectomy scenario, decreasing with more invasive treatment. In multivariate analyses the effect of treatment remained (p

Keywords: attitudes; breast cancer; cancer screening; decision making; early detection of cancer; informed choice; overdiagnosis; survey (search for similar items in EconPapers)
Date: 2020
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Persistent link: https://EconPapers.repec.org/RePEc:sae:medema:v:40:y:2020:i:1:p:42-51

DOI: 10.1177/0272989X19886886

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