Mammography screening decision aid for older women may cut overscreening

  • Schonberg MA & al.
  • JAMA Intern Med
  • 20 Apr 2020

  • curated by Miriam Davis, PhD
  • Univadis Clinical Summaries
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Takeaway

  • A mammography decision aid describing the benefits and harms of mammography for women age ≥75 years in primary care leads to about 9% fewer being screened.

Why this matters

  • Guidelines recommend that women age ≥75 years make informed decisions and not undergo screening if life expectancy is
  • Still, many women with shorter life expectancy are screened.
  • The current results suggest that this aid mitigates overscreening.

Study design

  • Cluster randomized trial with primary care provider (PCP) as the unit of randomization.
  • 546 women in 11 US primary care practices.
  • Before a PCP visit, women received a paper-based mammography screening decision aid (DA) laying out screening benefits and harms, or a home safety pamphlet (control).
  • Funding: NIH.

Key results

  • After 18 months, 51.3% in the intervention group vs 60.4% of controls had undergone mammography;
    • Adjusted risk ratio: 0.84 (P=.006).
  • The DA group was more likely than the control group:
    • To rate screening intentions as lower from pre- to postvisit (adjusted probabilities, 24.5% vs 15.3%);
    • To be more knowledgeable about screening benefits/harms (adjusted probabilities, 25.5% vs 11.7%); and
    • To have a documented discussion with their PCP about mammography (adjusted probabilities, 47.4% vs 38.9%).

Limitations

  • May not be nationally representative.