Most Women Unaware of Breast Cancer Overdiagnosis and Overtreatment Interview with:

Rebekah Nagler PhD Assistant professor Hubbard School of Journalism and Mass Communication University of Minnesota

Dr. Nagler

Rebekah Nagler PhD Assistant professor
Hubbard School of Journalism and Mass Communication
University of Minnesota What is the background for this study? What are the main findings?

Response: Both the American Cancer Society (ACS) and the U.S. Preventive Services Task Force (USPSTF) have stated that women in their 40s–or, in the case of ACS, women ages 40-44–should have the choice to decide when they want to start screening for breast cancer. These organizations recommend that women in this age group weigh the benefits and risks of mammography screening, with the goal of making an informed decision about when to start screening. Yet recent research has shown that women are more aware of the benefits of mammography screening than the harms, including overdiagnosis and overtreatment (doi:10.1001/jamainternmed.2017.2247). We therefore wondered whether women actually have the information they need to make informed screening decisions.

In a population-based sample of 429 U.S. women ages 35-55, we found that awareness of breast cancer overdiagnosis (16.5%) and overtreatment (18.0%) was low. Moreover, we found that most women did not find statements about these harms to be believable and persuasive. What should clinicians and patients take away from your report?

Response: There is good evidence that many women are aware of and value the benefits of mammography screening. Our study is the latest to suggest that women’s awareness of the risks of screening, including overdiagnosis and overtreatment, is substantially lower. We also found that, when presented with statements describing overdiagnosis and overtreatment, most women indicated that they did not find them to be persuasive. If we’re asking women in their 40s to weigh the benefits and risks of mammography screening, then we need to help them to understand the risks so that they can, in fact, make informed decisions. What recommendations do you have for future research as a result of this study?

Response: ​As in all research, replication is important: future studies, ideally also using​ large population-based samples​ should identify whether the trends we identified are stable.

​If so, then we need rigorous health communication research to inform clinical and/or public health interventions that could improve patient understanding of overdiagnosis, overtreatment, and other risks of screening. This may be particularly important for medically underserved communities, who may not have the opportunity to discuss screening’s benefits and risks with providers and who already experience disparities in informed decision making about cancer screening. Thank you for your contribution to the community.


Women’s Awareness of and Responses to Messages About Breast Cancer Overdiagnosis and Overtreatment: Results From a 2016 National Survey
Nagler, Rebekah H. PhD*; Franklin Fowler, Erika PhD; Gollust, Sarah E. PhD
Medical Care: October 2017 – Volume 55 – Issue 10 – p 879–885
doi: 10.1097/MLR.0000000000000798

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.


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