Objectives In Denmark, women are offered biennial breast cancer screening with mammography from age 50–69. Women above the age of 69 are discontinued from screening, owing to increased likelihood of harms, including overdiagnosis, and decreased likelihood of benefits. An American study shows a trend of substantial overscreening beyond the recommended age of discontinuation, which potentially lead to more overdiagnosis. The objective of this study is to explore women’s experiences, preferences, and reactions to the age-related discontinuation of mammography screening. This is important to prevent overscreening and hence overdiagnosis.
Method In 2019, we conducted a follow-up questionnaire survey to measure psychosocial consequences of mammography screening 12–14 years after initial screening. Psychosocial consequences were assessed using Consequences Of Screening – Breast Cancer (COS-BC). On the paper-and-pen, check-box questionnaire 24 women aged 66–87 had written unsolicited comments about their concerns of being discontinued from mammography screening due to age. We conducted 14 semi-structured ethnographic interviews that lasted one to four hours. Interviews were followed up two weeks after initial interview to allow for elaboration of thoughts, examine progression in knowledge about discontinuation and harms, while also confirming interpretation of interview.
Results While the discontinuation of screening is to avoid unintended harm and overdiagnosis, this study shows how the medical reasons is less known, while subjective notions of age-related marginalizing seem to be foregrounded. The women had high expectations to the benefits of screening and resisted contextual understanding of the potential unintended harms including overdiagnosis. The women perceived the discontinuation as a result of societal devaluation and emphasized that it was because society didn’t prioritize spending resources on screening older women. Thus, they were happy to know the medical rationale for the discontinuation. However, the women had gained reassurance through their participation and therefore strove for new means to obtain control over health after screening discontinuation, e.g., by opportunistic screening. Overall, the women believed the discontinuation to be ageist, felt devalued, and attained negative emotions, and sought out new means of reassurance as a consequence of the screening discontinuation.
Conclusions None of the participants were aware of the biomedical rationale for discontinuation of mammography screening. Instead, the women interpreted this as older women was worthless in a societal perspective and therefore they felt subject to ageism when discontinued. Knowing that discontinuation was due to increasing harms and decreasing benefit and not due to financial priorities and age discrimination, had a positive effect on the women’s perception of the discontinuation as ageist. This might call for interventions targeting the communication of the discontinuation from mammography screening, to potentially prevent overscreening and hence overdiagnosis.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.