Study: USPSTF mammo recommendations confuse women

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The breast cancer screening recommendations updated by the U.S. Preventative Services Task Force (USPSTF) in November 2009 have confused many women, suggesting a need for educational materials directed to consumers, a study published in the May issue of American Journal of Preventive Medicine reported.

The 2009 recommendations, which advised against routine screening for women aged 40 to 49 years and endorsed biennial mammograms for those aged 50 to 74 years, unleashed a firestorm among the public and breast imaging stakeholders. The task force issued a clarification two weeks after the initial update, advising women aged 40 to 49 to take an individual approach and consider “patient context.”

Linda B. Squiers, PhD, of RTI International, in Rockville, Md., and colleagues designed the study to gauge the volume and framing of the public discourse around the recommendations and determine women’s knowledge about the recommendations.

The two-part investigation included an analysis of news and social media focused on content published in print and in blog posts and a web survey of women aged 40 to 74 years. The researchers relied on LexisNexis to identify articles posted by leading newswires and in leading national newspapers from Nov. 1, 2009 to Jan. 31, 2010. They used Radian6 to locate blog posts and tweets published during the same period.

Next, Squiers and colleagues analyzed the content of a subset of 80 articles published between Nov. 16 and Nov. 30, 2009, and from Dec. 17, 2009 to Jan. 6, 2010, along with 71 of the top blog posts and 82 of the top tweets.

KN Knowledge Panel conducted the web survey of women aged 40 to 74 years.

During the analysis phase of the investigation, researchers completed cross-tabulations and logistic regressions to identify key variables and determine confounders and relationships between characteristics such as screening history, attention to guidelines and knowledge of guidelines.

After coding the sentiment of the content, Squiers and colleagues reported, “Of the 233 newspaper articles, blog posts and tweets coded, 51.9 percent were unsupportive and only 17.6 percent were supportive.” The two reasons for a lack of support were “the belief that delaying screening would lead to later detection of more advanced breast cancer and subsequently more breast cancer deaths and the belief that the recommendations reflected government rationing of healthcare.”

The web-based survey assessing demographic characteristics, attention to guidelines and the impact of the guidelines was presented to 2,356 women age 40 to 74, and researchers received 1,221 valid surveys.

The survey showed that although 50 percent of women correctly understood the reason for the debate, “only 6.2 percent of respondents indicated that the new recommendations helped them understand when to get a mammogram, whereas 30 percent said they made them confused.”

Nearly 80 percent of women age 40 to 49 could not correctly identify the new recommendation for women age 40 to 49. Fifty- to 74-year-old women performed slightly better, but 74.1 percent could not correctly identify the new guidelines applying to their age bracket.

Squiers and colleagues proposed several conclusions: "Media coverage of the new recommendations peaked immediately following their release and was unbalanced,” they attested. The researchers also referred to a media bias in favor of screening.

Given women’s confusion about the guidelines, “the USPSTF should consider strategies to develop clear messages regarding new recommendations for audiences such as clinicians, consumers and the media,” the authors suggested.

Squiers et al pointed out that both healthcare providers and women needed to understand guidelines before accepting them. Therefore, messages should be tailored to each target audience.

An accompanying commentary authored by Diana B. Petitti, MD, MPH, and Ned Calonge, MD, MPH, both members of USPSTF, noted that the findings “document our own impression there is a media bias in favor of screening.” Petitti and Calonge cited several advocacy groups that expressed support for the guidelines: National Women’s Health Network, National Breast Cancer Coalition and Breast Cancer Action.

They also suggested additional qualitative research into media coverage to better understand factors fueling negative media accounts about the recommendations.