Screening mammograms can cause significant stress for women—particularly for the 13 percent who receive news that their initial results are abnormal. Yet, for the majority of this 13 percent, additional imaging yields normal findings. False-positive findings occur at a significantly higher rate with annual screening than biennial screening and for women in their forties and seventies who do not have risk greater than the general population, research indicates that breast cancer mortality is not generally reduced with screening.
How many women without major risk factors for breast cancer would undergo screening mammography if they were made aware of rates of false positives and their level of risk with or without screening? A new paper by Ilya Ivlev, M.D., Ph.D., reports that evidence-based breast cancer screening patient decision aids had a significant influence on women’s decisions regarding mammography. The study, published in the March 2017 issue of the Journal of General Internal Medicine, is one of the first to examine the effects of these aids of screening plans on women’s intentions to be screened.
In a systematic review and meta-analysis of three randomized trials, Ivlev, a postdoctoral fellow in clinical informatics, found that, compared to typical care, 77 percent of women aged 38 to 50 who viewed a patient decision aid decided not to undergo screening mammography. The aid was developed by Karen Eden, Ph.D., medical informatics and clinical epidemiology professor at OHSU, and was based on the 2016 findings of Heidi Nelson, M.D., M.P.H., M.A.C.P., research professor and vice chair of medical informatics and clinical epidemiology and medicine at OHSU. Nelson’s research indicated breast cancer mortality with screening compared to nonscreening was not statistically significant for women of average risk who were in in their forties or seventies. However, her meta-analysis revealed that mortality was generally reduced for women aged 50 to 69.
Providing patients with the right treatment at the right time is the goal of these and other scientists at OHSU. Ivlev’s research may inform appropriate approaches to shared-decision making in determining whether to screen average-risk women in their forties.
In addition to Ivlev and Eden, co-authors were Erin N. Hickman, M.D., National Library of Medicine fellow in the Department of Medical Informatics and Clinical Epidemiology, and Marian S. McDonagh, Pharm.D., professor in the Department of Medical Informatics and Clinical Epidemiology and associate director of the Evidence-based Practice Center. The study was supported by United States National Library of Medicine Biomedical Informatics training grant T15LM007088.