40岁筛查适龄妇女乳腺X线摄影筛查偏好：一项美国全国性调查

Mammography Screening Preferences Among Screening-Eligible Women in Their 40s : A National U.S. Survey

ANNALS OF INTERNAL MEDICINE

影响因子:15.2

分区:医学1区 Top / 医学：内科1区

发表日期:2024 Aug

作者: Laura D Scherer, Carmen L Lewis, Kirsten McCaffery, Jolyn Hersch, Joseph N Cappella, Channing Tate, Brad Morse, Kelly Arnett, Bridget Mosley, Heather L Smyth, Marilyn M Schapira

DOI: 10.7326/M23-3325

摘要

美国预防服务工作组（USPSTF）最近将对40至49岁女性进行乳腺X线摄影筛查的建议从知情决策转变为每两年一次的筛查。尽管许多女性欢迎这一变化，但部分女性可能偏好不在40岁时接受筛查。为调查39至49岁妇女的乳腺癌筛查偏好，开展了一项基于概率的全国性美国调查。采用筛查决策辅助工具（DA）的前后调查设计（ClinicalTrials.gov：NCT05376241）。在线全国性美国调查。对象为495名无乳腺癌史或已知BRCA1/2基因突变的39至49岁妇女。提供关于筛查益处与风险的个性化乳腺癌风险估算的乳腺癌筛查DA。评估筛查偏好（在使用DA前后）、10年Gail模型风险估算，以及信息是否令人惊讶或与以往信息不同。在观看DA之前，27.0%的参与者倾向推迟筛查（即不按当前年龄接受乳腺X线摄影），而在观看后此比例升至38.5%。从未想过接受X线摄影的比例没有变化（DA前5.4%，DA后4.3%）。偏向推迟筛查的女性乳腺癌风险低于不推迟的女性。关于过度诊断的信息中，37.4%的参与者感到惊讶，而虚假阳性结果和筛查益处的惊讶比例分别为27.2%和22.9%。参与者的偏好可能受到当时USPSTF指南的影响。有些40多岁的女性在获知筛查的益处与风险后，倾向于选择推迟筛查。偏向推迟筛查的女性乳腺癌风险低于选择在当前年龄接受筛查的女性。许多女性对乳腺X线摄影的益处与风险信息感到惊讶。国家癌症研究所。

Abstract

The U.S. Preventive Services Task Force (USPSTF) recently changed its recommendation for mammography screening from informed decision making to biennial screening for women aged 40 to 49 years. Although many women welcome this change, some may prefer not to be screened at age 40 years.To conduct a national probability-based U.S. survey to investigate breast cancer screening preferences among women aged 39 to 49 years.Pre-post survey with a breast cancer screening decision aid (DA) intervention. (ClinicalTrials.gov: NCT05376241).Online national U.S. survey.495 women aged 39 to 49 years without a history of breast cancer or a known BRCA1/2 gene mutation.A mammography screening DA providing information about screening benefits and harms and a personalized breast cancer risk estimate.Screening preferences (assessed before and after the DA), 10-year Gail model risk estimate, and whether the information was surprising and different from past messages.Before viewing the DA, 27.0% of participants preferred to delay screening (vs. having mammography at their current age), compared with 38.5% after the DA. There was no increase in the number never wanting mammography (5.4% before the DA vs. 4.3% after the DA). Participants who preferred to delay screening had lower breast cancer risk than those who preferred not to delay. The information about overdiagnosis was surprising for 37.4% of participants versus 27.2% and 22.9% for information about false-positive results and screening benefits, respectively.Respondent preferences may have been influenced by the then-current USPSTF guideline.There are women in their 40s who would prefer to have mammography at an older age, especially after being informed of the benefits and harms of screening. Women who wanted to delay screening were at lower breast cancer risk than women who wanted screening at their current age. Many found information about the benefits and harms of mammography surprising.National Cancer Institute.