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254 Informing older women about the rationale for breast cancer screening cessation: a randomized trial of women aged 70–74 years in Australia
  1. Smith Jenna1,
  2. Cvejic Erin1,
  3. Houssami Nehmat2,
  4. Schonberg Mara3,
  5. Vincent Wendy4,
  6. Naganathan Vasi5,
  7. Jansen Jesse6,
  8. Dodd Rachael2,
  9. Wallis Katharine7,
  10. Mccaffery Kirsten1
  1. 1Sydney Health Literacy Lab, Sydney School of Public Health, The University of Sydney, NSW, Australia
  2. 2The Daffodil Centre, The University of Sydney, a joint venture with the Cancer Council NSW, NSW, Australia
  3. 3Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
  4. 4BreastScreen NSW, Sydney Local Health District, NSW, Australia
  5. 5Concord Clinical School, The University of Sydney and Centre for Education and Research on Ageing, Concord Hospital, NSW, Australia
  6. 6School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Netherlands
  7. 7General Practice Clinical Unit, Medical School, The University of Queensland, QLD, Australia

Abstract

Introduction Women in Australia are no longer invited for mammograms through the breast cancer screening program (BreastScreen) after 74 years of age due to uncertain benefits and potential harm. However, few women report knowing why screening invitations cease and suspect ageism, cost or lower risk of breast cancer. We tested the impact of providing older women approaching the upper BreastScreen invitation age (70–74 years) with information about the rationale for breast cancer screening cessation on informed choice.

Methods In a three-arm online randomised controlled trial, participants read a scenario where they received a letter from BreastScreen indicating their mammogram was clear. They were then randomised to receive 1) no additional information (usual care; control), 2) screening-cessation rationale in text form (e.g., the downsides of screening outweigh the benefits after age 74) or 3) screening-cessation rationale in an animation video. The primary outcome was informed choice defined as adequate knowledge (> within-sample median), and screening attitudes aligned with intention. Data were analysed using chi-square tests.

Results 372 women were included in the final analysis. Intervention arm participants (text n=128; animation n=128) had higher informed choice compared to controls (n=123); (control: 17.9%, reference; text: 32.0%, relative risk [RR]=1.21, p=.010; animation: 40.5%, RR=1.38, p<.001), higher knowledge (control: 23.6%; text: 60.2%, RR=1.92, p<.001; animation: 66.1%, RR=2.26, p<.001) and reduced screening intention (control: 82.9%; text: 35.9%, RR=1.29, p<.001; animation: 48.8%, RR=1.62, p<.001). Those who received the animation were less likely to report high positive screening attitudes compared to controls (41.3% vs. 62.6%, RR=0.64, p<.001).

Discussion Providing information to older women about the rationale for an upper age limit for the national breast screening program increased their informed decision-making.

Conclusion Further research should explore the impact of these interventions in practice and how to support general practitioners to further explain this information to older women.

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