Messaging strategies increase support for, intentions of breast cancer screening cessation

Key takeaways:

• Messaging strategies led to higher support for breast cancer screening cessation.
• Messages from multiple vs. one or no source led to higher intentions of screening cessation.

Among older women, messaging strategies significantly increased support for and intentions of breast cancer screening cessation, with the strongest effects occurring when messages were delivered over time from multiple sources, data show.

“One important contributor to overscreening is that patients have received pro-screening messages for many years from the media, the broader social environment and health care professionals. In contrast, there has been little messaging about the harms of overscreening, or that stopping screening may be appropriate for some women,” Nancy L. Schoenborn, MD, MHS, associate professor in the division of geriatric medicine and gerontology in the department of medicine at Johns Hopkins University School of Medicine, and colleagues wrote in JAMA Network Open. “Messaging strategies have been used successfully to reduce other unwanted health behaviors such as smoking but are an understudied approach to reduce overscreening.”

Using a nationally representative online panel, Schoenborn and colleagues conducted a randomized 2-wave clinical online survey trial with women aged 65 years or older without breast cancer from May to June 2023. Surveys described a hypothetical older women with serious illnesses and functional impairment to provide a scenario for someone where it would be appropriate for screening cessation. Messages were described as coming from a clinician, news story or family member and mentioned current guideline recommendations, an anecdote about women who had false-positive results and evidence on overdiagnosis. Participants were randomly assigned to four groups:

• group 1, the control group, receiving no messaging;
• group 2, receiving a single breast cancer screening cessation message from a clinician in wave 1 and no message in wave 2;
• group 3, receiving a message from a news story in wave 1 and a clinician in wave 2; or
• group 4, receiving a message from a family member in wave 1 and a clinician in wave 2.

Primary outcome was support for screening cessation and screening intentions, with higher values on a 7-point scale indicating stronger support and intentions for screening cessation.

Overall, 3,051 women (mean age, 72.8 years) completed wave 1, of whom 91.6% completed wave 2.

Receiving messaging at wave 1 from any source was associated with higher support for breast cancer screening cessation with similar effects when delivered by a clinician (mean score, 3.52) or a news story (mean score, 3.58), with a weaker effect when delivered by a family member (mean score, 2.94; P < .05).

Women in group 2 demonstrated higher support for screening cessation in wave 2 compared with the control group (mean scores, 3.14 vs. 2.68; P < .001). Researchers observed even stronger effects for women in group 3 and group 4, with mean scores of 4.23 and 4.12, respectively, compared with the control group and group 2 (P < .001 for all).

In addition, messaging effects on self-screening intentions were similar. The cumulative effects of messages from multiple sources in group 3 and group 4 led to higher intentions of screening cessation compared with messages from one source in group 2 or no messaging in the control group (P < .05 for all). Researchers noted that women aged 75 years or older or with a life expectancy of less than 10 years had higher intentions of screening cessation and larger messaging effects compared with the whole sample.

“This message can help inform public- or patient-facing materials and be incorporated into decision-support tools and electronic medical record prompts to optimize screening. This message can also be delivered as a stand-alone intervention to reduce overscreening,” the researchers wrote. “Future work should engage potential message sources to examine the feasibility and acceptability of multilevel messaging strategies and their effect on screening behavior.”