Majority women willing to accept risks of breast screening, research shows

Value in Health, the official journal of ISPOR (the professional society for health economics and outcomes research), announced today the publication of new research suggesting that, on average, most women were willing to accept the risk of unnecessary follow-ups for an increased chance of detecting a cancer in screening. The report of these findings, Investigating the Heterogeneity in Women's Preferences for Breast Screening: Does the Communication of Risk Matter? was published in the February 2018 issue of Value in Health.

The authors conducted an online survey to elicit preferences from 1018 female members of the public about a hypothetical national breast screening program. The survey focused on 3 attributes that drive screening attendance: (1) probability of detecting a cancer, (2) risk of unnecessary follow-up, and (3) out-of-pocket costs associated with travelling to a screening center or taking time off work.

The results of the study showed that all attributes were important but, on average, women placed most value on the screening program's ability to detect a cancer and most would participate in a breast screening program. "Women appear to be able to put up with high rates of false positive screens in order to detect an early breast cancer" said renowned specialist in cancer genetics Gareth Evans, MD, Professor in Medical Genetics and Cancer Epidemiology at The University of Manchester and Saint Mary's Hospital.

However, there was substantial variation in women's preferences. For some groups of women, characterized by ethnic minorities, the probability of participating in a screening program was low, driven by the benefit of cancer detection being outweighed by a dislike for unnecessary follow-ups.

Breast screening is offered to women aged between 50 and 70 years old in the United Kingdom and many other countries. It is offered on the premise that mammograms can identify cases of cancer earlier and help women start treatment quickly, preventing deaths from breast cancer. However, there have been debates about whether the benefits of screening outweigh the risks of biopsies and treatments for non-existent or slow-growing cancers.

"This study contributes to the debate about the relative harms and merits of breast screening programs by highlighting the drivers of screening attendance," said author Caroline Vass, BSc, MSc, PhD, of the Manchester Centre for Health Economics at The University of Manchester in the United Kingdom. "We forecasted that about 85% of women would participate in a breast screening program as currently offered by the National Health Service. Nevertheless, decision makers seeking to improve screening participation rates should consider the disparate needs of women when configuring services." ​

Comments

  1. Clare Foster Clare Foster Australia says:

    This lightweight analysis relates more to the lack of disclosure and hence understanding of breast screening effectiveness and risks. Women should be overtly, transparently and factually advised of the impacts of breastscreening including:

    •  the expected benefits (deaths reduced including disclosure that trial data is controversial, that mortality improvements more likely relate to treatment improvements occurring over the trial period, that two western countries have withdrawn screening programs based on independent reviews and that the global Cochrane Centre advises against screening)
    •  the risks/adverse consequences (over-diagnosis, unnecessary treatment, false positives, interval cancers…)
    •  the treatment consequences, complications and life time impacts (surgery, adjuvant therapy…) of, possibly, unnecessary treatment including reduced mortality in the case of
    radiation, chemotherapy and tamoxifen.

    It becomes a personal risk based decision whether it is worth the ~ 5:1 likely hood of over-diagnosis and high impact unnecessary treatment to reduce the possibility of dying from breast cancer by a small margin probably related to treatment improvement rather than screening. When presented with the full facts, the case of screening is not compelling and the consequences of ~50% (incl. DCIS) over-diagnosis hideous.

The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical.
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