Systematic review on women's values and preferences concerning breast cancer screening and diagnostic services.

Alexander G Mathioudakis,Zuleika Saz‐Parkinson,Minna Salakari,Luciana Neamtiu,Silvia Deandrea,Ivan Solà,Hector Pardo‐Hernandez,Pablo Alonso‐Coello,Anke Bramesfeld,Donata Lerda,Liisa Pylkkanen

doi:10.1002/pon.5041

Abstract

BackgroundThere is still lack of consensus on the benefit‐harm balance of breast cancer screening. In this scenario, women's values and preferences are crucial for developing health‐related recommendations. In the context of the European Commission Initiative on Breast Cancer, we conducted a systematic review to inform the European Breast Guidelines.MethodsWe searched Medline and included primary studies assessing women's values and preferences regarding breast cancer screening and diagnosis decision making. We used a thematic approach to synthesise relevant data. The quality of evidence was determined with GRADE, including GRADE CERQual for qualitative research.ResultsWe included 22 individual studies. Women were willing to accept the psychological and physical burden of breast cancer screening and a significant risk of overdiagnosis and false‐positive mammography findings, in return for the benefit of earlier diagnosis. The anxiety engendered by the delay in getting results of diagnostic tests was highlighted as a significant burden, emphasising the need for rapid and efficient screening services, and clear and efficient communication. The confidence in the findings was low to moderate for screening and moderate for diagnosis, predominantly because of methodological limitations, lack of adequate understanding of the outcomes by participants, and indirectness.ConclusionsWomen value more the possibility of an earlier diagnosis over the risks of a false‐positive result or overdiagnosis. Concerns remain that women may not understand the concept of overdiagnosis. Women highly value time efficient screening processes and rapid result delivery and will accept some discomfort for the peace of mind screening may provide.

Highlights

There is still lack of consensus on the benefit‐harm balance of breast cancer screening
Breast cancer screening with mammography, the only population‐based method for the early detection of breast cancer currently used, has been shown to reduce breast cancer mortality in women aged 50 to 74 years[2] and is widely implemented in most European countries.[3]
Mammography screening is associated with potential important undesirable effects, including overdiagnosis, and overtreatment, and false‐positive mammography results.[4]

Summary

Introduction

There is still lack of consensus on the benefit‐harm balance of breast cancer screening. In this scenario, women's values and preferences are crucial for developing health‐related recommendations. Methods: We searched Medline and included primary studies assessing women's values and preferences regarding breast cancer screening and diagnosis decision making. Women were willing to accept the psychological and physical burden of breast cancer screening and a significant risk of overdiagnosis and false‐positive mammography findings, in return for the benefit of earlier diagnosis. Conclusions: Women value more the possibility of an earlier diagnosis over the risks of a false‐positive result or overdiagnosis.

Methods

Results

Conclusion