ASPO Abstracts
Older women's views and experiences of mammography screening in relation to aging, health status and healthcare overuse
Category: Behavioral Science & Health Communication
Conference Year: 2020
Abstract Body:
Purpose: Breast cancer (BC) screening guidelines recommend shared decision-making and cessation of
screening in women ≥75 years with limited life expectancy or poor health. Yet, despite insufficient evidence of
long-term clinical benefit and concerns of overtreatment, over half of women ≥75 years undergo mammography
screening. We examined older women’s experiences, beliefs, and opinions about BC screening in relation to
aging and health and their perceptions of unnecessary healthcare. Methods: Using purposeful sampling, 19
women, ages 71-83 years, with a recent screening mammogram were recruited from a breast imaging clinic and
completed a semi-structured interview. Transcribed interviews were coded using a thematic analytic approach.
Results: The majority of women were Hispanic (63%) and received annual mammograms (71%). Women’s
motivation for obtaining mammogram included agency over their health (“I feel like I’m doing something for my
health”), peace of mind from normal results, ease, accessibility and insurance coverage of mammography, and
mammography being a personal habit. All women reported one or more prompts for screening including their own
calendar reminder, providers’ referrals and healthcare system reminder letters/calls. Women deemed the benefits
of early detection and peace of mind to outweigh the only perceived screening harm, temporary discomfort.
Overall, women did not feel older age or medical conditions should keep them from receiving mammography;
most felt growing older meant they needed mammograms more than ever (“it’s something I’ll do until I die”). No
one perceived screening as overuse or unnecessary care (“as long as the doctors let me do it, I’ll keep doing it.”)
Women did not report discussing mammography cessation or harms with their providers, and some expressed
they would insist on receiving mammograms even if not recommended by their provider. Conclusions: Older
women stated strong intentions for continued BC screening and did not endorse reducing or stopping screening
with increasing age or poor health. Their opinions and behaviors were supported by providers and system-level
prompts. Focusing on both patient and provider/systems level factors may be needed to improve guideline
implementation.
Keywords: Mammography; over screening; breast cancer; health communication; implementation research