Awareness of the 2009 US Preventive Services Task Force recommended changes in mammography screening guidelines, accuracy of awareness, sources of knowledge about recommendations, and attitudes about updated screening guidelines in women ages 40--49 and 50+

BMC Public Health (Impact Factor: 2.26). 10/2012; 12(1):899. DOI: 10.1186/1471-2458-12-899
Source: PubMed


The US Preventive Services Task Force updated mammography recommendations in 2009, recommending against routine screening for women ages 40–49 and reducing recommended frequency for women 50+. The recommendation changes were highly controversial and created conflicting recommendations across professional organizations. This study examines overall awareness of the changes, accuracy of knowledge about changes, factors related to both overall awareness and accuracy, sources of knowledge about changes, and attitudes about the new recommendations.

National telephone survey of 508 women, half aged 40–49 and half 50+, conducted one year after the update (November/December 2010; cooperation rate was 36%). Measures include awareness, accuracy, source of knowledge, interactions with providers, and attitudes about the changes.

Fewer than half of women were aware of the guideline changes. Younger, more educated, and higher income women were more aware. Of those who were aware, only 12% correctly reported both change in age and frequency. Accuracy was not associated with demographics. The majority learned of changes through the media and the majority had negative attitudes about the changes.

Despite widespread coverage of the recommendation changes, overall awareness in the relevant population is low. Increasing awareness and addressing attitudes about the changes is necessary to ensure the use of recommendations to impact screening behavior.

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    • "Understanding the extent to which women are aware of guideline changes, the controversy that has erupted, and how they reconcile inconsistent messages from a variety of information sources is critical to developing interventions that can improve decision-making processes related to breast cancer screening. A few recent studies have begun to assess attitudes, knowledge and potential interventions for appropriate use of mammograms [37,38]. Yet more specific exploration of communication needs, especially for diverse women, is needed. "
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    ABSTRACT: The 2009 U.S. Preventive Services Task Force (USPSTF) changed mammography guidelines to recommend routine biennial screening starting at age 50. This study describes women's awareness of, attitudes toward, and intention to comply with these new guidelines. Women ages 40-50 years old were recruited from the Boston area to participate in focus groups (k = 8; n = 77). Groups were segmented by race/ethnicity (Caucasian = 39%; African American = 35%; Latina = 26%), audio-taped, and transcribed. Thematic content analysis was used. Participants were largely unaware of the revised guidelines and suspicious that it was a cost-savings measure by insurers and/or providers. Most did not intend to comply with the change, viewing screening as obligatory. Few felt prepared to participate in shared decision-making or advocate for their preferences with respect to screening. Communication about the rationale for mammography guideline changes has left many women unconvinced about potential disadvantages or limitations of screening. Since further guideline changes are likely to occur with advances in technology and science, it is important to help women become informed consumers of health information and active participants in shared decision-making with providers. Additional research is needed to determine the impact of the USPSTF change on women's screening behaviors and on breast cancer outcomes.
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    ABSTRACT: Recommendations for the frequency of mammography screening vary across several professional advisory groups. In 2009, the United States Preventive Services Task Force Guidelines reduced screening to biennially for women 50-74 years old. Drivers of this change were false-positive results and unnecessary biopsies, exposure to radiation, and treatment of cancers that would never develop. Despite the recommendation, surveys show that screening has actually increased since the change. A review of the individual woman's risk and a more balanced approach addressing both the benefits and harms of screening is required so that patients can make an informed choice.
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    ABSTRACT: Background The patient voice remains underrepresented in clinical and public health interventions. To inform interventions that strive to improve access to breast and cervical cancer screening and follow-up among low-income populations, we explored recommendations from low-income women pursuing health care in the safety net. Methods Semi-structured interviews were conducted among women receiving follow-up care for an abnormal breast or cervical cancer screening result or a positive cancer diagnosis in federally qualified health centers, free clinics, or an academic cancer center in the Chicago metropolitan area. Findings Of the 138 women interviewed in the parent study, 52 women provided recommendations for improving access to screening and follow-up care. Most were between 41 and 65 years old (62%) and African American (60%) or White (25%). Recommendations included strengthening community-based health education with more urgent messaging, strategic partnerships, and active learning experiences to increase patient engagement, which women regarded as a key driver of access. Women also suggested increasing access by way of changes to health care delivery systems and policy, including more direct patient–provider and patient–clinic communications, addressing delays caused by high patient volume, combining preventive services, expanding insurance coverage, and adjusting screening guidelines. Conclusions This exploratory study demonstrates important insights from the patient lens that may help to increase the acceptability and efficacy of community and clinical interventions aimed at improving access to breast and cervical cancer screening and follow-up. Further research is needed to identify appropriate integration of patient input into interventions, practice, and policy change.
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