Randomized Trial of Information for Older Women About Cessation of Breast Cancer Screening Invitations

Jenna Smith; Erin Cvejic; Nehmat Houssami; Mara A Schonberg; Wendy Vincent; Vasi Naganathan; Jesse Jansen; Rachael H Dodd; Katharine Wallis; Kirsten J McCaffery

doi:10.1007/s11606-024-08656-3

Randomized Trial of Information for Older Women About Cessation of Breast Cancer Screening Invitations

J Gen Intern Med. 2024 Feb 26. doi: 10.1007/s11606-024-08656-3. Online ahead of print.

Authors

Affiliations

¹ Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
² The Daffodil Centre, The University of Sydney, a joint venture with the Cancer Council NSW, Sydney, NSW, Australia.
³ Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
⁴ BreastScreen NSW, Sydney Local Health District, Sydney, NSW, Australia.
⁵ Faculty of Medicine and Health, Concord Clinical School, The University of Sydney, Sydney, Australia.
⁶ Department of Geriatric Medicine, Centre for Education and Research On Ageing, Concord Hospital, Concord, NSW, Australia.
⁷ Faculty of Health, Medicine and Life Sciences, School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands.
⁸ General Practice Clinical Unit, Medical School, The University of Queensland, Brisbane, QLD, Australia.
⁹ Edward Ford Building (A27), The University of Sydney, Sydney, NSW, Australia. kirsten.mccaffery@sydney.edu.au.

PMID: 38409512
DOI: 10.1007/s11606-024-08656-3

Abstract

Background: Older women receive no information about why Australia's breast screening program (BreastScreen) invitations cease after 74 years. We tested how providing older women with the rationale for breast screening cessation impacted informed choice (adequate knowledge; screening attitudes aligned with intention).

Methods: In a three-arm online randomized trial, eligible participants were females aged 70-74 years who had recently participated in breast screening (within 5 years), without personal breast cancer history, recruited through Qualtrics. Participants read a hypothetical scenario in which they received a BreastScreen letter reporting no abnormalities on their mammogram. They were randomized to receive the letter: (1) without any rationale for screening cessation (control); (2) with screening cessation rationale in printed-text form (e.g., downsides of screening outweigh the benefits after age 74); or (3) with screening cessation rationale presented in an animation video form. The primary outcome was informed choice about continuing/stopping breast screening beyond 74 years.

Results: A total of 376 participant responses were analyzed. Compared to controls (n = 122), intervention arm participants (text [n = 132] or animation [n = 122]) were more likely to make an informed choice (control 18.0%; text 32.6%, p = .010; animation 40.5%, p < .001). Intervention arm participants had more adequate knowledge (control 23.8%; text 59.8%, p < .001; animation 68.9%, p < .001), lower screening intentions (control 17.2%; text 36.4%, p < .001; animation 49.2%, p < .001), and fewer positive screening attitudes regarding screening for themselves in the animation arm, but not in the text arm (control 65.6%; text 51.5%, p = .023; animation 40.2%, p < .001).

Conclusions: Providing information to older women about the rationale for breast cancer screening cessation increased informed decision-making in a hypothetical scenario. This study is an important first step in improving messaging provided by national cancer screening providers direct to older adults. Further research is needed to assess the impact of different elements of the intervention and the impact of providing this information in clinical practice, with more diverse samples.

Trial registration: ANZCTRN12623000033640.

Grants and funding

2016719/National Health and Medical Research Council