In 2009 the U.S. Preventive Services Task Force, an independent panel that provides recommendations to the Department of Health and Human Services, recommended changes to the health screening guidelines for breast cancer. The panel’s concern revolves around issues of false positive screenings and the consequences of the same. More generally, the risk conceptions were for the population at large. They did note that people with specific risk factors should consult their doctors to see if earlier screenings were a good idea for them.
When I posted about this at the time, the general reactions suggested a much more personal perspective on the issue than the population-wide focus of the Task Force. Totally understandable. Voices noting the consequences of false positives and reminding people that screenings don’t catch every cancer were few and far between.
An article in the American Journal of Obstetrics and Gynecology (full article requires subscription and/or payment) has conducted a study of women’s attitudes about screenings for breast cancer after the changes in recommendations (H/T Medical News Today). The study surveyed women between the ages of 39 and 49 (the recommendations increased the age for widespread mammograms from 40 to 50). The participants were getting their annual exam, and were asked to read one of two articles before completing the survey. According to the article abstract, some of the study findings include (boldface mine):
- 88% overestimated lifetime Breast cancer (BrCa) risk.
- 89% want yearly mammograms in forties.
- 86% felt changes were ‘unsafe’, and even if doctor-recommended, 85% would not delay screening until age 50.
- Those with a friend/relative with BrCa were more likely to want annual mammography in their forties (92% vs 77% P=0.001), and feel changes unsafe (92% vs 69% P=<0.0001).
- Participants with previous false-positive mammograms were less likely to accept doctor-recommended screening delay until age 50 (8% vs 20%) P=0.01.
The last point is particularly interesting to me, as it suggests that receiving an inaccurate result for a disease makes one more likely to get additional screening. I would have expected people to be less trusting of screening after a false positive. Readers with psychology backgrounds, what am I missing?
Regardless of why, we have some additional evidence suggesting that people will be more likely to get screenings that most won’t need. In fact, some of them may be harmed by these screenings. And all of this will cost. Unfortunately, the politics associate with fear (regardless of the level of risk) are hard to disperse.
Pasco Phronesis 