Q&A: Discussing mammography risks 'does not seem to undermine' screening decisions

Key takeaways:

• When told about the benefits and potential risks that come with mammography, more women opted to wait until they were older to undergo screening.
• PCPs should not be afraid to inform patients of potential risks associated with mammography.

Informing patients of the benefit-harm balance associated with mammography screening is beneficial and did not hinder overall screening decisions, according to results of a national probability-based U.S. survey.

Laura D. Scherer, PhD, associate professor in the department of medicine at the University of Colorado’s Anschutz Medical Campus, and colleagues conducted a study, published in Annals of Internal Medicine, that examined breast cancer screening preferences among 495 women aged 39 to 49 years.

They evaluated the effects of informing patients of the risk-benefit balance associated with mammography and assessed the effect of personal risk on screening decisions.

Healio spoke with Scherer to learn more about the study’s findings and what primary care providers need to know.

Healio: What did the intervention entail and what did you find?

Scherer: The intervention was a breast cancer screening decision aid for women in their 40s that provided information about the benefits and downsides of mammography, as well as an estimate of the participants’ breast cancer risk in the next 10 years.

We found that when women were informed, more women wanted to wait until they were older or until age 50 to undergo mammogram. There was no increase in the number of women who never wanted to undergo mammograms.

Women who wanted to delay screening had a lower risk for cancer, on average, and were concerned about the downsides like false positives and overdiagnosis. Women who wanted to have screening at their current age were at higher risk, were concerned about their family cancer history, and were less likely to be concerned about false-positives and overdiagnosis.

Healio: Why is this topic so important?

Scherer: It shows that women have varying perspectives on breast cancer screening when they are informed. For some, it makes sense to wait to screen to maximize the potential for benefit and minimize the potential for harm. For others, especially those with a family history or higher risk for cancer, it makes sense to screen sooner.

Healio: The USPSTF recently updated its recommendation on screening, and other major medical organizations also have conflicting guidelines. What should PCPs tell their patients? What role does individualized care play in these decisions?

Scherer: Ultimately, the decision to receive any preventive care is a personal choice, and it’s better when people make choices that are informed. Some people do care about the downsides of screening, and they should be informed about those possibilities. Informing people of the range of harms and benefits does not seem to undermine their intentions to screen overall, so physicians should not hesitate to fully inform women about potential consequences of screening. However, I want to also acknowledge the practical reality that PCPs often don’t have time to convey all of this information to their patients, and so an important question is how to get this information to people who do want to know.

Healio: In a related editorial, Victoria Mintsopoulos, MD, MSc, and Michele B. Nadler, MD, wrote about how well your study’s sample represents average-risk women in the U.S., noting that breast cancer incidence occurs at younger ages among Black and Hispanic women. What is the importance of health equity in breast cancer screening?

Scherer: This study showed that the majority of women do want to have breast cancer screening in their 40s, which reinforces the importance of reducing barriers to receiving desired preventive care. An important implication of this study is that we need to focus on reducing existing barriers while also respecting people’s autonomy to make an informed choice. These are not conflicting goals.

Healio: What is the take-home message?

Scherer: Not everyone wants to have mammograms at age 40. Some people are interested in creating a screening plan that incorporates their personal risk for cancer and that maximizes the chance for benefit and minimizes the chance for harm.

References:

• Mintsopoulos V, et al. Ann Intern Med. 2024;doi:10.7326/M24-0885.
• Scherer LD, et al. Ann Intern Med. 2024;doi:10.7326/M23-3325.