Study: Most women reject USPSTF guidelines
Nearly 90 percent of women in their 40s believe they should have annual mammograms, according to a randomized trial published online April 14 in American Journal of Obstetrics & Gynecology. Designed to assess attitudes about the U.S. Preventive Services Task Force (USPSTF) guidelines, which were revised in November 2009, the trial revealed prevailing intense skepticism, leading the authors to suggest, “The pathway to implementation of evidence-based guidelines may be more about improving America’s health literacy and less about simply mining the science and making the recommendations.”

Researchers from the University of Massachusetts Memorial Hospital in Worcester designed the convenience sample survey both to assess women’s attitudes about the guidelines and to determine whether their attitudes were influenced by exposure to media opinion pieces. The survey was administered to 244 women between the ages of 39 and 49 who presented to their obstetrician-gynecologist for annual exams during a three-month period in the spring of 2010.

The initial survey covered personal experience with mammography, breast cancer history and family/friends with breast cancer. Women were randomized into two groups. One group read a media piece in favor of the guidelines changes, while the second read an opinion piece suggesting that “the guidelines were politically motivated and potentially dangerous for women.”

Finally, women completed an additional questionnaire pertaining to their attitudes about mammography and personal plans related to screening.

The researchers completed multiple analyses, with the first designed to determine whether participants had different responses after they read one of the articles and the second constructed to detect other factors that may have influenced women’s responses.

Many women reported previous experiences with mammography and breast cancer. Sixty-seven percent underwent a workup resulting from an abnormal mammogram and 76 percent had a family member or close friend with breast cancer, according to the study's lead author Autumn S. Davidson, MD, of University of Massachusetts Memorial Hospital, and colleagues.

Davidson et al also noted that most women overestimated breast cancer risk; 78 percent of participants estimated the average woman’s lifetime cancer risk as greater than 12 percent (the average for women in her 40s). The average response to the question “Approximately what percentage of the women in the U.S. do you think will get breast cancer in their lifetime?” was 37 percent.

Participants expressed strong feelings about screening mammography. “Among participants randomized to the favorable article, 84 percent felt [they should have yearly mammograms in their 40s]. Among those randomized to the unfavorable article, the percentage was 93 percent.”

Although the difference was statistically significant, the overwhelming majority in both groups favored annual screening, offered the researchers. Furthermore, 84 percent would not be comfortable delaying screening mammography even if recommended by their physician.

Women with a close friend or relative with breast cancer were more likely to support screening mammography with 91 percent of those with a friend or relative with breast cancer categorizing the guidelines as unsafe compared with 69 percent of those without a friend or relative with breast cancer.

Among the 14 percent of women who believed the guidelines are safe, nearly half still did not want to delay screening until age 50 if their physicians recommended it as reasonable, according to the researchers.

Davidson and colleagues acknowledged the personalization of the issue of breast cancer, noting that 77 percent of respondents had a friend or family member with the disease. Ninety-two percent of these women felt they should continue annual mammograms. “This finding supports a body of research suggesting that the public interprets health policy in relation to their own personal experience, and does not have a sophisticated understanding of evidence-based medicine,” wrote Davidson.

The researchers emphasized the statistically significant difference between those who had and had not experienced a false positive mammogram in terms of their discomfort complying with the new guidelines. They suggested the women viewed the false positive as a near miss rather than a false alarm, a contradiction to the conclusions of the USPSTF.

Davidson and colleagues pointed to several limitations to the study. Participants were primarily white, middle class and affluent and presenting for preventive care. The survey was administered within months of the guidelines and ensuing public debate. Opinions, they offered, may have moderated with time.

The researchers concluded by emphasizing the need to improve health literacy. They also noted the value of incremental changes in screening practices and called for all stakeholders to “recognize the crucial role the press plays in shaping public opinions.”