Oral Presentation NSW State Cancer Conference 2023

Providing women aged 70-74 years with the rationale for cessation of breast cancer screening invitations: Results from a randomised trial (#27)

Jenna Smith 1 , Erin Cvejic 1 , Nehmat Houssami 2 , Mara Schonberg 3 , Wendy Vincent 4 , Vasi Naganathan 5 6 , Jesse Jansen 7 , Rachael Dodd 2 , Katharine Wallis 8 , Kirsten McCaffery 1
  1. Sydney Health Literacy Lab, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
  2. The Daffodil Centre, The University of Sydney, a joint venture with the Cancer Council NSW, Sydney, NSW, Australia
  3. Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States of America
  4. BreastScreen NSW, Sydney Local Health District, Sydney, NSW, Australia
  5. Concord Clinical School, The University of Sydney, Sydney, NSW, Australia
  6. Centre for Education and Research on Ageing, Concord Hospital, Sydney, NSW, Australia
  7. School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
  8. General Practice Clinical Unit, Medical School, The University of Queensland, Brisbane, QLD, Australia

Aims: Women in Australia cease to be invited to breast cancer screening through the national breast screening program (BreastScreen) after the age of 74 years due to uncertain benefits and potential harm. However, few women report knowing why screening invitations cease and suspect ageism, cost or being at lower risk of breast cancer. We aimed to test the impact of providing older women approaching the upper BreastScreen invitation age (70-74 years) with information about the rationale for breast cancer screening cessation on informed choice.

Methods: We conducted a three-arm online randomised controlled trial. Participants were female, aged 70-74 years, living in Australia, recruited through Qualtrics. Exclusion criteria was personal breast cancer history and not having had breast screening in the past five years. Participants read a scenario where they received a letter from BreastScreen indicating that their mammogram showed no abnormalities. Participants were randomised to receive the letter either 1) without information as per usual care (control), 2) the letter with screening-cessation rationale presented in text form (e.g., the downsides of screening outweigh the benefits after 74) or 3) the letter with screening-cessation rationale presented in an animation video. The primary outcome was informed choice defined as adequate knowledge (higher score than the within-sample median), and screening attitudes aligned with screening intention.

Results: Between March 8th to 29th, 2023, 376 women were recruited and included in the final analysis. Compared to controls (n=122), intervention arm participants (text [n=132] or animation [n=122]) were more likely to make an informed choice (control: 17.9%, text: 32.0%, relative risk [RR]=1.21, p=.010; animation: 40.5%, RR=1.38, p<.001). Intervention arm participants also had more adequate knowledge (control: 23.6%; text: 60.2%, RR=1.92,p<.001; animation: 66.1%, RR=2.26, p<.001), lower screening intentions (control: 82.9%; text: 35.9%, RR=1.29,p<.001; animation: 48.8%, RR=1.62, p<.001) and fewer positive screening attitudes in the animation arm only (41.3% vs. 62.6% [control], RR=0.64, p<.001). 

Discussion: Providing information to older women aged 70-74 years about the rationale for an upper age limit for the national breast screening program increased their likelihood of informed decision-making in a hypothetical scenario. Our study was limited as the sample may not represent women aged 70-74 years who would typically attend to BreastScreen services in Australia. 

Conclusion: Further research is needed to understand the impact of these interventions in practice and how best to support general practitioners to further explain this information to older women.