Women's views on overdiagnosis in breast cancer screening: a qualitative study
Women's views on overdiagnosis in breast cancer screening: a qualitative study
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DOI：
10.1136/bmj.f158
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发表时间：
2013-01-23
影响因子：
105.7
通讯作者：
McCaffery, Kirsten
中科院分区：
文献类型：
--
作者：
Hersch, Jolyn;Jansen, Jesse;McCaffery, Kirsten
目的探讨女性对乳房x线摄影筛查中过度诊断的性质和程度的反应，并探讨过度诊断的意识如何影响对筛查的态度和意图。设计采用焦点小组进行定性研究，包括解释过度诊断的介绍，结合不同的已发表的发病率估计（1-10%,30%,50%）和筛查的死亡率益处信息，并进行指导小组讨论。背景：澳大利亚悉尼参与者50名年龄在40-79岁之间、无乳腺癌个人病史、受教育程度和筛查参与程度不同的女性。结果先前对乳腺癌过度诊断的认识很少。女性的反应通常是惊讶，但大多数人都开始理解这个问题。对过度诊断的反应和对其程度的不同估计是不同的。最高的估计（50%）使一些妇女认为有必要对筛查进行更仔细的个人决策。相比之下，较低和中等估计值（1-10%和30%）对态度和意图的影响有限，许多妇女仍然致力于筛查。对于一些妇女来说，这些信息引起的关注不是是否进行筛查，而是是否治疗筛查发现的癌症或考虑其他方法（如观察等待）。信息偏好各不相同：许多妇女认为考虑过度诊断并就是否进行筛查做出知情选择很重要，但许多妇女希望被鼓励进行筛查。结论：不同社会经济背景的女性能够理解乳房x光检查中过度诊断的问题，并且她们普遍重视这方面的信息。对筛查意图的影响可能在很大程度上取决于过度诊断率。对许多人来说，过度诊断将是一种新的、违反直觉的现象，可能会以意想不到的方式影响筛查和治疗决策，这强调了仔细沟通的必要性。
Objective To elicit women's responses to information about the nature and extent of overdiagnosis in mammography screening (detecting disease that would not present clinically during the woman's lifetime) and explore how awareness of overdiagnosis might influence attitudes and intentions about screening.Design Qualitative study using focus groups that included a presentation explaining overdiagnosis, incorporating different published estimates of its rate (1-10%, 30%, 50%) and information on the mortality benefit of screening, with guided group discussionsSetting Sydney, AustraliaParticipants Fifty women aged 40-79 years with no personal history of breast cancer and with varying levels of education and participation in screening.Results Prior awareness of breast cancer overdiagnosis was minimal. Women generally reacted with surprise, but most came to understand the issue. Responses to overdiagnosis and the different estimates of its magnitude were diverse. The highest estimate (50%) made some women perceive a need for more careful personal decision making about screening. In contrast, the lower and intermediate estimates (1-10% and 30%) had limited impact on attitudes and intentions, with many women remaining committed to screening. For some women, the information raised concerns, not about whether to screen but whether to treat a screen detected cancer or consider alternative approaches (such as watchful waiting). Information preferences varied: many women considered it important to take overdiagnosis into account and make informed choices about whether to have screening, but many wanted to be encouraged to be screened.Conclusions Women from a range of socioeconomic backgrounds could comprehend the issue of overdiagnosis in mammography screening, and they generally valued information about it. Effects on screening intentions may depend heavily on the rate of overdiagnosis. Overdiagnosis will be new and counterintuitive for many people and may influence screening and treatment decisions in unintended ways, underscoring the need for careful communication.