Low Awareness of Breast Cancer Overdiagnosis and Overtreatment Among U.S. Women

Charlie Plain | September 27, 2017
Sarah Gollust smiling
Associate Professor Sarah Gollust

A new study conducted in collaboration with the School of Public Health shows that most American women aren’t aware that routine mammograms can lead to overdiagnosis and overtreatment of breast cancer.

The study, written by senior author Associate Professor Sarah Gollust and lead author Assistant Professor Rebekah Nagler from the Hubbard School of Journalism and Mass Communication, was published in the journal Medical Care.

The survey study sought to assess women’s awareness and perceptions of overdiagnosis and overtreatment — two of the main potential harmful effects of breast cancer screening. Overdiagnosis refers to detection of cancers that grow so slowly that they will never cause health problems during a woman’s lifetime. Overdiagnosis often leads to overtreatment, which refers to unnecessary treatments — such as surgery or medications — that expose women to various potential complications and side effects while offering minimal health benefits.

The study revealed that only approximately 16 percent of women were aware of the potential risk of overdiagnosis from breast cancer screening and just 18 percent were aware of the concept of overtreatment. Additionally, women younger than 40 were least likely to have heard about overdiagnosis.

When the women were presented with statements regarding overdiagnosis and overtreatment, most had negative perceptions of the messages. For example, less than 1-in-4 women agreed with and found statements about overdiagnosis and overtreatment to be believable. Even fewer women evaluated them as strong arguments to consider in their own mammography decision making. Women who recently had a mammogram were particularly unconvinced by these statements. Those with a routine source of medical care, such as a family doctor or neighborhood clinic, were less likely to believe statements regarding overdiagnosis as well.

The researchers said that, although it is difficult to pinpoint just how common cancer overdiagnosis is, there is growing expert consensus that the phenomenon is real and may require a re-evaluation of aggressive breast cancer screening strategies. They argue that it is important for patients to understand potential harms so that they can carefully consider whether and when to begin breast cancer screening.

In particular, the researchers believe their findings have implications for communicating with patients about the potential harms of breast cancer screening. They emphasized that women with a strong history of following advice to get mammograms might be an important target for interventions to improve informed decision-making.

Nagler and the study’s coauthors recommend pursuing additional health communication research to inform communication interventions that could improve patient understanding of overdiagnosis and overtreatment and promote the appropriate use of screening.

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