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Informing Women About Overdetection in Breast Cancer Screening: Two-Year Outcomes From a Randomized Trial

BACKGROUND: Supporting well-informed decisions about breast cancer screening requires communicating that inconsequential disease may be detected, leading to overdiagnosis and overtreatment. Having previously shown that telling women about overdetection improved informed choice, we investigated effec...

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Autores principales: Hersch, Jolyn, Barratt, Alexandra, McGeechan, Kevin, Jansen, Jesse, Houssami, Nehmat, Dhillon, Haryana, Jacklyn, Gemma, Irwig, Les, McCaffery, Kirsten
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8562961/
https://www.ncbi.nlm.nih.gov/pubmed/33871631
http://dx.doi.org/10.1093/jnci/djab083
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author Hersch, Jolyn
Barratt, Alexandra
McGeechan, Kevin
Jansen, Jesse
Houssami, Nehmat
Dhillon, Haryana
Jacklyn, Gemma
Irwig, Les
McCaffery, Kirsten
author_facet Hersch, Jolyn
Barratt, Alexandra
McGeechan, Kevin
Jansen, Jesse
Houssami, Nehmat
Dhillon, Haryana
Jacklyn, Gemma
Irwig, Les
McCaffery, Kirsten
author_sort Hersch, Jolyn
collection PubMed
description BACKGROUND: Supporting well-informed decisions about breast cancer screening requires communicating that inconsequential disease may be detected, leading to overdiagnosis and overtreatment. Having previously shown that telling women about overdetection improved informed choice, we investigated effects on screening knowledge and participation over 2 years. METHODS: We conducted a community-based, parallel-group, randomized controlled trial in Australia. Participants were women aged 48-50 years, without personal or strong family history of breast cancer, who had not undergone mammography in the past 2 years. We randomly assigned 879 women to receive the intervention decision aid (evidence-based information on overdetection, breast cancer mortality reduction, and false-positives) or control decision aid (identical but without overdetection information). We interviewed 838 women postintervention and recontacted them for follow-up at 6 months and 1 and 2 years. Main outcomes for this report are screening knowledge and participation. RESULTS: We interviewed 790, 746, and 712 participants at 6 months, 1, and 2 years, respectively. The intervention group demonstrated superior knowledge throughout follow-up. After 2 years, conceptual knowledge was adequate in 123 (34.4%) of 358 women in the intervention group compared with 71 (20.1%) of 354 control participants(odds ratio = 2.04, 95% confidence interval = 1.46 to 2.85). Groups were similar in total screening participation (200 [55.1%] vs 204 [56.0%]; = 0.97, 95% confidence interval = 0.73 to 1.29). CONCLUSIONS: A brief decision aid produced lasting improvement in women’s understanding of potential consequences of screening, including overdetection, without changing participation rates. These findings support the use of decision aids for breast cancer screening.
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spelling pubmed-85629612021-11-03 Informing Women About Overdetection in Breast Cancer Screening: Two-Year Outcomes From a Randomized Trial Hersch, Jolyn Barratt, Alexandra McGeechan, Kevin Jansen, Jesse Houssami, Nehmat Dhillon, Haryana Jacklyn, Gemma Irwig, Les McCaffery, Kirsten J Natl Cancer Inst Articles BACKGROUND: Supporting well-informed decisions about breast cancer screening requires communicating that inconsequential disease may be detected, leading to overdiagnosis and overtreatment. Having previously shown that telling women about overdetection improved informed choice, we investigated effects on screening knowledge and participation over 2 years. METHODS: We conducted a community-based, parallel-group, randomized controlled trial in Australia. Participants were women aged 48-50 years, without personal or strong family history of breast cancer, who had not undergone mammography in the past 2 years. We randomly assigned 879 women to receive the intervention decision aid (evidence-based information on overdetection, breast cancer mortality reduction, and false-positives) or control decision aid (identical but without overdetection information). We interviewed 838 women postintervention and recontacted them for follow-up at 6 months and 1 and 2 years. Main outcomes for this report are screening knowledge and participation. RESULTS: We interviewed 790, 746, and 712 participants at 6 months, 1, and 2 years, respectively. The intervention group demonstrated superior knowledge throughout follow-up. After 2 years, conceptual knowledge was adequate in 123 (34.4%) of 358 women in the intervention group compared with 71 (20.1%) of 354 control participants(odds ratio = 2.04, 95% confidence interval = 1.46 to 2.85). Groups were similar in total screening participation (200 [55.1%] vs 204 [56.0%]; = 0.97, 95% confidence interval = 0.73 to 1.29). CONCLUSIONS: A brief decision aid produced lasting improvement in women’s understanding of potential consequences of screening, including overdetection, without changing participation rates. These findings support the use of decision aids for breast cancer screening. Oxford University Press 2021-04-19 /pmc/articles/PMC8562961/ /pubmed/33871631 http://dx.doi.org/10.1093/jnci/djab083 Text en © The Author(s) 2021. Published by Oxford University Press. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Articles
Hersch, Jolyn
Barratt, Alexandra
McGeechan, Kevin
Jansen, Jesse
Houssami, Nehmat
Dhillon, Haryana
Jacklyn, Gemma
Irwig, Les
McCaffery, Kirsten
Informing Women About Overdetection in Breast Cancer Screening: Two-Year Outcomes From a Randomized Trial
title Informing Women About Overdetection in Breast Cancer Screening: Two-Year Outcomes From a Randomized Trial
title_full Informing Women About Overdetection in Breast Cancer Screening: Two-Year Outcomes From a Randomized Trial
title_fullStr Informing Women About Overdetection in Breast Cancer Screening: Two-Year Outcomes From a Randomized Trial
title_full_unstemmed Informing Women About Overdetection in Breast Cancer Screening: Two-Year Outcomes From a Randomized Trial
title_short Informing Women About Overdetection in Breast Cancer Screening: Two-Year Outcomes From a Randomized Trial
title_sort informing women about overdetection in breast cancer screening: two-year outcomes from a randomized trial
topic Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8562961/
https://www.ncbi.nlm.nih.gov/pubmed/33871631
http://dx.doi.org/10.1093/jnci/djab083
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