Perceptions of overdetection of breast cancer among women 70 years of age and older in the USA: a mixed-methods analysis

• Type of Material: Article
• Authors: Monique R. Pappadis, University of Texas; Robert J. Volk, University of Texas; Shilpa Krishnan, Emory University; Susan C. Weller, University of Texas; Elizabeth Jaramillo, University of Texas; Diana Stewart Hoover, University of Texas; Sharon H. Giordano, University of Texas; Alai Tan, Ohio State University; Kristin M. Sheffield, Eli Lilly and Company; Ashley J. Housten, University of Texas; James S. Goodwin, University of Texas
• Language: English
• Date: 2018-06-01
• Publisher: BMJ Publishing Group: Open Access
• Publication Version: Final Published Version
• Copyright Statement: © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1136/bmjopen-2018-022138
• Title of Journal or Parent Work: BMJ Open
• ISSN: 2044-6055
• Volume: 8
• Issue: 6
• Start Page: e022138
• End Page: e022138
• Grant/Funding Information: This work was supported by the Agency for Healthcare Research and Quality (AHRQ) (grant number R24 HS022134); the National Institute on Aging (NIA) (grant number P30 AG024832); the Cancer Prevention and Research Institute of Texas (CPRIT) (grant number RP160674); the National Cancer Institute (NCI) (grant number K05 CA13492; R25T CA5773); the National Institute on Minority Health and Health Disparities (NIMHD) (L60 MD009326; K99MD011485); the Cancer Center Support Grant to The University of Texas MD Anderson Cancer Center (grant number P30 CA016672); the National Institute on Disability, Independent Living and Rehabilitation Research (NIDILRR) (grant number 90AR5009; 90SFGE0002; the National Institute on Drug Abuse (NIDA) (grant number K23 DA040933); and The University of Texas MD Anderson Cancer Center’s Duncan Family Institute for Cancer Prevention and Risk Assessment.
• Keywords: OVERDIAGNOSIS; Life Sciences & Biomedicine; SCREENING MAMMOGRAPHY; RESPONSES; AWARENESS; OVERTREATMENT; General & Internal Medicine; Medicine, General & Internal; Science & Technology; MESSAGES; DECISION AID
• Research Categories: Health Sciences, Oncology

Abstract

OBJECTIVES: Current research on the perceptions of overdiagnosis or overdetection of breast cancer has largely been conducted outside of the USA and with women younger than 70 years.Therefore, we explored older women's perceptions about the concept of overdetection of breast cancer and its influence on future screening intentions. DESIGN: Mixed-methods analysis using purposive sampling based on race/ethnicity, age and educational level. Semistructured interviews, including two hypothetical scenarios illustrating benefits and harms of screening and overdetection, were analysed using inductive and deductive thematic approaches. An inferential clustering technique was used to assess overall patterns in narrative content by sociodemographic characteristics, personal screening preferences or understanding of overdetection. SETTING: Houston/Galveston, Texas, USA. PARTICIPANTS: 59 English-speaking women aged 70 years and older with no prior history of breast cancer. RESULTS: Very few women were familiar with the concept of overdetection and overtreatment. After the scenarios were presented, half of the women still demonstrated a lack of understanding of the concept of overdetection. Many women expressed suspicion of the concept, equating it to rationing. Women who showed understanding of overdetection were more likely to express an intent to discontinue screening, although 86% of the women stated that hearing about overdetection did not influence their screening decision. Themes identified did not differ by race/ethnicity, education, age or screening preferences. Differences were identified between women who understood overdetection and women who did not (r=0.23, p<0.001). CONCLUSIONS: Many older women did not understand the concept of overdetection, in addition to being suspicious of or resistant to the concept. Providing older women with descriptions of overdetection may not be sufficient to influence screening intentions.