Messaging Strategies to Reduce Breast Cancer Over-Screening in Older Women

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PROJECT SUMMARY Mammography screening may decrease breast cancer mortality and morbidity but the potential benefits are often delayed for many years while significant harms can occur in the short term. While breast cancer incidence increases with age, older women are also at higher risks for screening-related harms and burdens compared to younger women. The harms of routine screening outweigh the benefits among older women with limited life expectancies, but many of these women continue to be screened, highlighting the need for interventions to promote appropriate screening cessation in order to reduce over-screening in older women. Our prior research suggests that older adults are willing to stop routine cancer screening when recommended by their clinicians. We also found that clinicians are increasingly willing to recommend that older patients forgo screening when harms outweigh the benefits. However, patients at times receive contradictory messages from their family, friends, or the news media which weaken the impact of the clinicians' recommendations and contribute to over-screening. This project aims to examine how messages from clinicians, family and friends, and media, separately and together, impact breast cancer screening intentions among older women, with the goal of identifying messaging strategies that most effectively reduce breast cancer over-screening. We seek to accomplish this goal through 3 aims. We will first establish which messages intended to reduce breast cancer over-screening are considered most credible in a national online survey of 600 older women (Aim 1). Then, we will conduct a two-wave online survey experiment with 3,000 older women to examine the combined effects of consistent and conflicting messages from different sources—including clinicians, social relationships, and the news media — on breast cancer screening beliefs, attitudes, and intentions over time (Aim 2). Lastly, we will conduct focus groups with multi-disciplinary stakeholders to devise strategies to deliver the messages from Aim 2 that most effectively reduced over-screening intentions (Aim 3). The proposed project will identify effective messaging strategies to promote appropriate screening cessation and reduce over-screening for breast cancer in older women and engage stakeholders to inform message dissemination. The results will directly inform a communication intervention as a next step to reduce breast cancer over-screening among older women.