Reducing geriatric breast cancer screening through cessation messaging

Reducing geriatric breast cancer screening through cessation messaging | Image Credit: © Peakstock - © Peakstock - stock.adobe.com.

Support for and intentions of breast cancer screening cessation are increased among older women through a breast cancer screening cessation message, according to a recent study published in JAMA Network Open.¹

While mammography screening is associated with reduced morbidity and mortality among patients with breast cancer, it can also lead to adverse outcomes including false positive and overdiagnosis. These harms may outweigh the benefits in older women with functional impairment, chronic conditions, and limited life expectancy.

Screening is recommended in women aged up to 75 years, but many women continue to receive screening beyond this point. Proscreening messages may contribute to this, especially since messaging about the harms of overscreening is lacking. Notably, breast cancer screening is provided to 50.6% of women aged at least 75 years.²

Messaging strategies may be utilized to reduce unwanted health behaviors, with efficacy likely impacted by the message source.¹ Therefore, investigators conducted a randomized clinical online survey experiment to evaluate the efficacy of messages about stopping screening from various sources.

Women aged 65 to 75 years were included in the analysis and randomized into groups receiving a different number of messages over 2 points. Additional differences between groups included the source of the messages and the message content.

The study team developed a survey instrument describing a hypothetical patient aged 75 years. Exposure to a message with rationales for screening cessation was randomized, mentioning guideline recommendations, an anecdote about a woman with false-positive results, and evidence on diagnosis.

Sources of information included a primary care physician, a news story, and a close family member. Support for screening cessation was the primary outcome, determined based on participants’ belief the hypothetical patient in the survey should get a mammogram in the next 2 years.

There were 4 groups created. Group 1 never received the screening cessation message, while group 2 only received it during wave 1 from a clinician, group 3 received it wave 1 from a news story and wave 2 from a clinician, and group 4 received it wave 1 from a family member and wave 2 from a clinician.

Participants’ screening cessation intentions for themselves in the next 2 years was reported as the secondary outcome. Both the primary and secondary outcomes were measured during both waves in all groups.

There were 3051 women included in wave 1, 33.8% of whom were aged 75 years or older while 66.2% were aged 65 to 74 years. Of participants, 4.9% were Hispanic, 8.9% non-Hispanic Black, 82.1% non-Hispanic White, and 4.1% other race or ethnicity. Wave 2 completion was reported by 91.6% of these participants.

Support for screening cessation at wave 1 was lowest in group 1, with a mean score of 2.66 on the 7-poin scale. When a screening cessation message was delivered by a clinician, this score significantly rose to 3.52, vs 3.58 for a news story and 2.94 for a family member.

Group 1 also had the lowest score for supporting screening cessation at wave 2, with a mean score of 2.68. In groups 2, 3, and 4, these scores were 3.14, 4.23, and 4.12, respectively. This indicated a 17.8% increase in participants supporting screening cessation of the hypothetical patient in group 1 vs a 47% increase in group 3.

A similar magnitude of effects was reported for screening cessation intentions for oneself. The mean score was only slightly higher in group 2 vs group 1, at 2.59 vs 2.38, respectively. However, significantly increased scores were reported in groups 3 and 4, at 2.95 and 2.98, respectively.

These results indicated increased support for breast cancer screening cessation among older women from a message describing the rationale for screening cessation. Investigators recommended future work determine the feasibility of multilevel messaging strategies and their impact on screening behavior.

References

1. Schoenborn NL, Gollust SE, Nagler RH, et al. Effect of messaging on support for breast cancer screening cessation among older US women: A randomized clinical trial. JAMA Netw Open. 2024;7(8):e2428700. doi:10.1001/jamanetworkopen.2024.28700
2. Yourman L, Bergstrom JN, Bryant EA,et al. Variation in receipt of cancer screening and immunization by 10-year life expectancy. J Gen Intern Med. 2024;39(3):440-449. doi:10.1007/s11606-023-08439-2