Women in their 40s may delay breast cancer screening with mammography after learning about the exam's pros and cons, a study published July 15 in the Annals of Internal Medicine found.
Researchers led by Laura Scherer, PhD, from the University of Colorado in Denver found that after a decision aid was introduced, more women leaned toward delaying screening. This was especially true for women deemed to be at lower risk of developing breast cancer. However, the number of women saying they never wanted to have mammograms did not increase after they were informed.
“Ultimately, the decision to receive any preventive care is a personal choice, and it's usually better when people make choices that are informed,” Scherer told AuntMinnie.com.
The U.S. Preventive Services Task Force (USPSTF) in 2024 changed its recommendation for when to start breast cancer screening. While the previous guidelines recommended women begin biennial breast cancer screening at age 50 and informed decision-making for women at age 40, the latest recommendation (grade B) is for women to begin biennial screening at age 40.
Radiology societies praised the USPSTF’s decision to lower the minimum screening age from 50 to 40 but added that screening should be performed annually.
Scherer and colleagues noted that while many women may welcome this change, some may not want to start screening at a younger age. The investigators conducted a national probability-based survey to assess breast cancer screening preferences among women ages 39 to 49. They conducted their study prior to the April 2024 USPSTF mammography guideline update.
The study included data from 495 U.S. women without a prior history of breast cancer or a known BRCA1/2 genetic mutation. Scherer's group introduced a mammography screening decision aid that provided information about screening benefits and harms. The women also received a personalized breast cancer risk estimate.
Before viewing the decision aid, 27% of the women reported leaning toward delaying screening as opposed to undergoing mammography at their current age. After the decision aid was introduced, that number jumped to 38.5%.
The researchers reported no increase in the number of women who never wanted mammography, at 5.4% before the decision aid and 4.3% after the decision aid was introduced. Women who preferred delaying mammography screening had lower breast cancer risk than those who preferred not to delay.
“This means that providing information about mammograms does not deter women from screening altogether,” Scherer said.
Finally, the survey indicated that 37.4% of participants were surprised about information regarding overdiagnosis, and 27.2% and 22.9% of the women were surprised about information regarding false-positive results and screening benefits, respectively.
Scherer said that “many” women in this study reported wanting to follow their doctor’s recommendation about when to have mammograms, and many of those doctors will recommend annual mammograms starting at age 40.
“It’s reassuring to know that people at higher risk were more likely to want to screen earlier and that providing information about mammograms doesn’t deter women from getting mammograms altogether,” she told AuntMinnie.com.
In an accompanying editorial, Victoria Mintsopoulos, MD, from the University of Toronto in Canada, and Michele Nadler, MD, of Princess Margaret Cancer Centre, also in Toronto, wrote that when weighing the benefits and harms of breast cancer screening, the focus should move toward identifying the best ways to provide shared decision-making or using decision aids.
Mintsopoulos and Nadler highlighted that this makes way for screening-eligible women to have access to providers who can engage with them using these tools, as well as access to sought-after screening services following informed consent.
“Ideally, quality metrics could adapt to these outcomes across all groups to ensure informed and equitable care,” they wrote.
The full study can be found here.
